Is hormone therapy safe in prostate cancer in a 58-year-old?

Question

Hello doctor,

I am confused because my 58-year-old husband has prostate cancer, but I keep reading conflicting information and need to understand what this means for our family. His PSA was 22.4, and the biopsy showed a Gleason score of 8, which the urologist said is aggressive. They want to do surgery next month, but I am worried about complications like incontinence and how it will affect our intimacy. We have two daughters in their 20s, and I am scared that prostate cancer might be hereditary and increase their risk of breast or ovarian cancer. I tested positive for the BRCA1 mutation five years ago, which is why I had a preventive mastectomy. The genetic counsellor said prostate cancer can sometimes be linked to the same gene mutations. He has been healthy his whole life, except for high cholesterol, so this diagnosis came as a complete shock. The oncologist mentioned hormone therapy might be needed if surgery does not get all the cancer, but I am worried about side effects. Should our daughters get genetic testing now? Also wondering if I could somehow be exposed to chemotherapy drugs if he needs treatment, and how that might affect me since I have a history of blood clots.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

I can see why you are feeling overwhelmed; a lot is happening at once, and some of it connects directly to your own health history. Your husband’s PSA and Gleason score indicate an aggressive prostate cancer, so the doctors are suggesting surgery early to give the best chance of controlling it. The main risks after surgery are urinary leakage and erectile dysfunction; these vary depending on nerve-sparing techniques, age, and how much cancer has spread locally. Some men recover most bladder control within months, but intimacy changes can happen and may need treatment later. Since you carry a BRCA1 mutation, there is a higher chance that his prostate cancer could be linked to it.

If that is the case, your daughters may have a 50 percent chance of inheriting the mutation, which can raise risks for breast, ovarian, and, in men, prostate cancer. Genetic testing for them can be considered now, especially since they are adults, as it can guide screening and preventive strategies. If hormone therapy is needed later, side effects can include fatigue, hot flashes, weight gain, and mood changes, but these can be managed. Regarding chemotherapy: if he ever needs it, the drugs are given in a controlled clinical setting, and normal household contact with him is safe. Basic hygiene precautions (like avoiding contact with body fluids for a day or two after infusion) are enough, and your clotting history would not be affected by just living with him.

I hope this information will be helpful to you.

Thanks.