What questions should I ask my oncologist about locally advanced Prostate Cancer

Questions to Ask Your Oncologist About Locally Advanced Prostate Cancer

I'll help you prepare for your conversation with your oncologist. These questions are organized by topic to help you understand your diagnosis, treatment options, and what to expect.

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UNDERSTANDING YOUR DIAGNOSIS

1. What exactly does "locally advanced" mean for my prostate cancer?

• Ask your doctor to clarify whether the cancer is confined to the prostate or has extended into surrounding tissues
• Understanding this helps you grasp why certain treatments are recommended

2. What is my Gleason score, and what does it tell us?

• The Gleason score rates how aggressive your cancer cells look under a microscope (ranges from 6-10)
• This score significantly influences treatment decisions and prognosis

3. What is my PSA level, and how does it compare to normal ranges?

• PSA (prostate-specific antigen) is a blood test that measures a protein your prostate produces
• Your doctor should explain what your specific number means for your situation

4. Have imaging tests been done to check if the cancer has spread?

• Ask specifically about: PSMA PET scans, MRI, CT scans, or bone scans
• These help determine if cancer has spread beyond the prostate (metastases)

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GENETIC AND MOLECULAR TESTING

5. Should I have genetic testing done on my tumor tissue? According to the CancerPatientLab webinars on prostate cancer treatment, most men in the community are not getting adequate testing. Ask your doctor about:

• DNA and RNA sequencing of your tumor tissue to identify genetic mutations
• Specific mutations to test for, including:
  • BRCA1/BRCA2 mutations (which may respond to PARP inhibitors)
  • CDK12 mutations (which create gene fusions that T-cells can recognize)
  • Mismatch repair deficiency (which indicates potential immunotherapy benefit)
  • PTEN loss or other tumor suppressors

6. Should I have germline (inherited) genetic testing?

• This tests your normal DNA to see if you carry inherited cancer risk genes
• Important for your family members and for identifying treatment options

7. What about liquid biopsy testing?

• A blood test that can detect circulating tumor DNA (ctDNA)
• Can help monitor your disease over time without invasive procedures

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TREATMENT OPTIONS & STRATEGY

8. What is the standard treatment approach for locally advanced prostate cancer? According to treatment guidelines, locally advanced prostate cancer typically involves:

• Local therapy (surgery or radiation)
• Androgen deprivation therapy (ADT) - drugs that lower testosterone
• Sometimes additional systemic therapy

Ask your doctor which approach they recommend for YOUR specific situation.

9. Am I a candidate for radiation therapy, surgery, or both?

• Radiation: External beam radiation therapy (EBRT) or brachytherapy (radioactive seeds placed in the prostate)
• Surgery: Radical prostatectomy (surgical removal of the prostate)
• Ask about the pros and cons of each for your case

10. If radiation is recommended, should it include the pelvic lymph nodes?

• This depends on your risk factors and PSA level
• Ask whether your doctor recommends treating just the prostate or a larger area

11. What is androgen deprivation therapy (ADT), and how long would I need it?

• ADT uses drugs to lower testosterone, which feeds prostate cancer growth
• Ask about:
  • Duration (months? years?)
  • Specific drugs being considered
  • Side effects you should expect
  • Whether it will be combined with other treatments

12. Should I have treatment intensification? According to recent prostate cancer guidelines, treatment intensification is now standard of care. This means:

• Combining multiple therapies (radiation + systemic therapy, for example)
• Using potent androgen receptor blockers
• Ask if this applies to your case and why

13. Are there clinical trials available for my stage?

• Ask your doctor about trials testing new combinations or approaches
• Trials may offer access to newer treatments not yet widely available

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MONITORING & FOLLOW-UP

14. How will we monitor my response to treatment? Ask about:

• PSA testing: How often? What PSA level would indicate progression?
• Imaging scans: How often? What type (PSMA PET, MRI, CT)?
• Other blood tests: What markers will be tracked?
• Functional assessments: Quality of life, symptoms, side effects

15. What does "biochemical recurrence" mean, and what would we do if my PSA rises?

• This is when PSA starts rising after treatment, even if scans look normal
• Ask what the plan would be if this happens

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SIDE EFFECTS & QUALITY OF LIFE

16. What side effects should I expect from my treatment?

• From radiation: Urinary symptoms, bowel symptoms, fatigue
• From ADT: Hot flashes, sexual dysfunction, bone loss, weight gain, fatigue
• Ask which side effects are most common and how they're managed

17. How can we manage side effects to maintain my quality of life? According to prostate cancer treatment guidelines, there's increasing emphasis on whole health, including:

• Cardiovascular health
• Mental health support
• Nutrition and diet
• Exercise and physical activity
• Bone health (especially important with ADT)

Ask your doctor about supportive care resources.

18. Will this treatment affect my sexual function, and what are my options?

• Be direct about this - it's an important quality-of-life issue
• Ask about medications or other interventions that might help

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PRACTICAL CONSIDERATIONS

19. How long will treatment take, and what's the schedule?

• Understand the time commitment
• Ask about work, travel, and activity restrictions

20. What should I do if I have side effects or concerns between appointments?

• Get clear instructions on how to reach your care team
• Ask about emergency symptoms that need immediate attention

21. Should I see a medical oncologist, radiation oncologist, or both?

• Ask about your care team and how they communicate
• Consider asking for a "quarterback" - one doctor coordinating your overall care

22. Are there support resources available?

• Ask about:
  • Support groups (in-person or online)
  • Nutritionists
  • Mental health counselors
  • Patient education materials

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IMPORTANT CONTEXT FROM EXPERT SOURCES

According to the CancerPatientLab webinars on prostate cancer treatment (featuring experts like Oliver Sartor, MD, and Andrew Armstrong, MD):

• Treatment intensification is now standard of care for locally advanced disease, meaning combining therapies often produces better outcomes than single treatments
• Genetic testing should be routine - about 20% of patients have actionable mutations that point to specific targeted drugs
• You should ask about testing diversity - getting multiple perspectives on your cancer (DNA sequencing, RNA analysis, imaging) helps guide better decisions
• Plan ahead - discuss with your doctor which treatments to use now and which to reserve for future if needed

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QUESTIONS TO BRING TO YOUR APPOINTMENT

Print or write down:

1. My Gleason score and PSA level
2. Results of any imaging tests
3. Whether genetic testing has been recommended
4. My treatment options and why one is recommended over others
5. Expected timeline and side effects
6. How we'll monitor treatment response
7. What happens if treatment doesn't work as expected

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FINAL THOUGHT

The most important question you can ask is: "Based on my specific situation - my age, health, Gleason score, PSA level, and genetic test results - why do you recommend THIS particular treatment approach over the alternatives?"

Your oncologist should be able to explain the reasoning clearly. If something doesn't make sense, ask for clarification. You're a partner in your care.

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This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.