How to manage prostate cancer with PSA levels of 18.7?

Question

Hello doctor,

I am feeling very confused and overwhelmed about the situation with my seventy-one-year-old husband, who has been diagnosed with prostate cancer, and how this may affect me as his wife and caregiver.

His prostate-specific antigen level increased rapidly from 4.2 to 18.7 within six months, and the biopsy showed aggressive cancer with a Gleason score of 8 in 10 out of twelve cores. The urologist has recommended a radical prostatectomy followed by radiation therapy. However, I am very concerned about the possible side effects, such as urinary incontinence and erectile dysfunction, and how these may affect both of our lives and our relationship.

He is also considering hormone therapy with Lupron injections. I have read that this treatment can cause mood changes, hot flashes, and bone loss, which sound very similar to the menopausal symptoms that I experienced. I am worried about how these changes may affect his emotional well-being and our day-to-day life together.

I would also like to know whether I need to take any special precautions when handling his medications, or if I should be concerned about exposure to chemotherapy if he needs it in the future.

Additionally, I have learned that prostate cancer can sometimes be associated with a family history of breast or ovarian cancer. My aunt had breast cancer, and this has made me wonder whether I should consider genetic testing for myself.

This entire experience feels overwhelming, and I feel that very few people talk about how prostate cancer affects wives and female partners emotionally, physically, and psychologically. Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com

I hope you are doing well, and I wish your husband good health and recovery. I truly understand and appreciate the fear and anxiety you are experiencing, especially as your husband has become your highest priority.

Regarding his treatment, I recommend radiotherapy (radiation treatment that destroys cancer cells using high-energy rays) combined with hormonal therapy or androgen deprivation therapy, or ADT (treatment that lowers male hormone levels to slow cancer growth). I do not recommend surgical treatment in this case.

Surgical treatment, such as radical prostatectomy (complete removal of the prostate gland), often leads to urinary incontinence (loss of bladder control) and erectile dysfunction (difficulty achieving or maintaining an erection). Unfortunately, these side effects can be permanent and significantly affect the quality of life.

Radiotherapy may cause temporary side effects such as gastrointestinal upset (bowel irritation, diarrhea, or rectal discomfort) and urinary tract infections (infections affecting the bladder or urinary system). These side effects are usually mild and reversible and improve once treatment is completed.

Hormonal therapy can lead to bone loss or osteoporosis (weakening of bones). To prevent this, we prescribe a monthly injection called denosumab (a medication that strengthens bones and reduces fracture risk). Hormonal therapy may also cause weight gain and mood changes, but these effects are reversible. As the prostate-specific antigen, PSA (a blood marker used to monitor prostate cancer activity), level decreases, the dose of hormonal therapy can be reduced, and these symptoms gradually improve, often returning to better than before.

Regarding concerns about contagion or exposure, your husband is not contagious. External beam radiotherapy (radiation delivered from outside the body) does not make him radioactive, and there is no risk to you or any family members living in the same household.

Given the family history of prostate cancer and breast cancer, we recommend that sons and daughters over the age of twenty-five undergo prophylactic genetic testing (testing to identify inherited cancer-related gene mutations). If any genetic mutation is detected, it can be managed according to each individual’s risk and medical condition.

I hope this explanation reassures you. Please try not to be afraid and approach the situation with calmness and confidence. Joining support groups for spouses and partners of people with prostate cancer can be extremely helpful, as they provide emotional support and shared experiences from others in similar situations.

If you have any further questions or concerns at any time, please do not hesitate to reach out.

Treatment plan: Radiotherapy combined with androgen deprivation therapy (ADT).

Follow-up: In seven days.

I hope this helps you.

Kindly revert if there are any queries.

Thank you.