Is hormonal therapy safe for prostate cancer patients?

Question

Hi doctor,

I am writing on behalf of my 68-year-old father-in-law, who was recently diagnosed with prostate cancer, classified as Gleason score 7 (3+4). He also has chronic kidney disease at stage 3 and type 2 diabetes.

The urologist has suggested hormonal therapy before starting radiation treatment, but my father-in-law is worried about potential side effects such as fatigue, bone weakness, and mood changes.

We are particularly concerned because my mother-in-law went through early menopause and experienced severe bone loss. Could he face similar issues with androgen deprivation therapy? His most recent PSA level was 18 ng/mL, and his creatinine level was 1.8 mg/dL. How can we nutritionally support him to help prevent weakness or depression during this time?

Additionally, will hormonal therapy have a permanent effect on his sexual function, or is there a possibility of improvement after the treatment ends? Should we consider seeking a second opinion before proceeding with radiation therapy?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

A Gleason score of 7 (3 + 4) for prostate cancer is considered intermediate risk. While it is not the most aggressive, it is significant enough to warrant active treatment rather than simple monitoring. A PSA (prostate-specific antigen) level of 18 ng/mL also supports this classification.

Given that he has chronic kidney disease (CKD) stage 3 and type 2 diabetes, any treatments must balance cancer control with safety and tolerability.

Androgen deprivation therapy (ADT), typically administered through injections such as Leuprolide, Goserelin, or Degarelix, temporarily suppresses testosterone, a hormone that prostate cancer cells depend on for growth.

In cases of intermediate-risk disease, short-term ADT, typically lasting four to six months, before and during radiation, is suggested:

It will shrink the prostate and improve the effectiveness of radiation treatment, and reduce the risk of recurrence after radiation.

This is a standard, evidence-based approach, especially for men with a PSA level greater than 10 ng/mL or a Gleason score of 7 or higher.

The side effects of ADT largely stem from lower testosterone levels. Here are some possible effects, what to expect, and how to manage them:

Fatigue and muscle loss: Encourage gentle resistance exercises such as light weights, resistance bands, and walking. Ensure adequate protein intake of 1 to 1.2 g/kg/day.
Bone thinning osteopenia or osteoporosis: This can occur, especially with more than 6 months of therapy. The patient is at higher risk due to age and CKD. Consider starting calcium 1000 to 1200 mg/day and vitamin D 800 to 1000 IU/day if there are no contraindications. A DEXA dual-energy X-ray absorptiometry, bone-density scan may be advisable before starting therapy, along with the potential consideration of bone-protective medications such as bisphosphonates or denosumab.
Mood changes or depression: Regular physical activity, social interaction, good sleep hygiene, and possibly low-dose antidepressants may be helpful. Family support is also crucial.
Hot flashes or night sweats: These symptoms usually improve over time and may respond to lifestyle modifications for cooling. If severe, medications like low-dose Venlafaxine or Gabapentin may be used.
Metabolic effects worsening diabetes and cholesterol: It is important to note that ADT can elevate blood sugar levels and lipids. His diabetologist should monitor glucose closely and may need to adjust medications accordingly.

It is advisable to consult with the following specialists:

A consultant urologist.
A consultant medical oncologist.
A consultant psychiatrist.
A consultant psychotherapist.

It is possible to experience bone loss similar to what your mother-in-law experienced during menopause, but it is manageable and often preventable with early monitoring and supplements.

I hope this answers your query. Feel free to reach out anytime.

Thank you.