My father has prostate cancer. Does he need hormone therapy?

Question

Hello doctor,

My father, aged 68, was recently diagnosed with prostate cancer. His PSA level is 18 ng/mL, and the biopsy showed a Gleason score of 7 (3+4). My MRI indicates localized disease.

The oncologist mentioned the options of surgery or radiotherapy. But, I have a few concerns:

How do we decide which approach gives better long-term control?
Are there any major side effects, like urinary leakage or sexual dysfunction, that we should be prepared for?
Also, will hormone therapy be needed even if the tumor has not spread?
How often should PSA be monitored after initial treatment to check for recurrence, and at what level is recurrence usually suspected?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for sharing your questions in detail. I completely understand that receiving a prostate cancer diagnosis can be stressful for you and your family.

Asking precise and thorough questions is the right step and will help you make informed decisions.

Based on the information you provided, your father is 68 years old, his PSA (prostate-specific antigen) is 18 ng/mL (nanograms per milliliter), the biopsy showed a Gleason score of 7 (3+4), and the MRI (magnetic resonance imaging) indicates localized disease.

This suggests a moderate-risk prostate cancer that is still confined to the prostate. These details are important for guiding treatment decisions.

At this stage, the two main treatment options mentioned are surgery and radiotherapy. Both approaches offer good chances of long-term disease control, but they differ in potential side effects and recovery.

Surgery may have short-term risks such as bleeding or infection, and long-term risks including urinary incontinence and sexual dysfunction in some patients.

Radiotherapy can cause bladder or bowel irritation and sometimes affect sexual function, but its side effects are generally manageable and often reversible.

Choosing between the two usually depends on overall health, patient preference, and the experience of the treating center.

Regarding hormone therapy, if the disease is localized, it is usually not needed initially. Hormone therapy is often used in more advanced stages or in combination with radiotherapy to enhance treatment effectiveness.

However, for localized disease, it may be considered later, based on PSA results or disease progression. After initial treatment, regular PSA monitoring is essential. Typically, PSA is checked every three to six months during the first two years, then every six to 12 months afterward.

Recurrence is usually suspected when the PSA level shows a consistent rise, although the exact threshold depends on the type of initial treatment and should be closely monitored by the oncologist.

For now, I recommend reviewing the treatment options thoroughly with your oncology and urology team, asking about potential side effects and recovery after each option, and sharing any new reports or MRI results with your doctors to make the best individualized decision.

Please keep me updated if there are any changes or new reports, so I can provide further guidance. Most patients do very well with consistent follow-up and family support, so try to stay positive.

I hope this helps you.

Thank you.