What questions should I ask my oncologist about metastatic Prostate Cancer

Key Questions to Ask Your Oncologist About Metastatic Prostate Cancer

Based on current prostate cancer treatment approaches, here are the most important questions to help you understand your specific situation and treatment options:

UNDERSTANDING YOUR DIAGNOSIS

1. What type of metastatic prostate cancer do I have?

• Is my cancer "castrate-sensitive" (still responds to hormone therapy) or "castrate-resistant" (continues growing despite low testosterone)?
• Where has my cancer spread? (bones, lymph nodes, liver, lungs, or other organs?)
• What is my Gleason score and PSA level?

According to the CancerPatientLab webinar "Update on Prostate Cancer Treatments," these distinctions are critical because they determine which treatment pathways are most appropriate for you.

2. What genetic/molecular testing have I had or should I have?

• Have you tested my tumor for specific mutations (BRCA1/BRCA2, mismatch repair deficiency, microsatellite instability)?
• Should I get germline testing (testing my normal DNA) to identify inherited mutations?
• Would a liquid biopsy (blood test for circulating tumor DNA) be helpful to monitor my disease?

Dr. [removed] Sartor emphasizes that genetic testing identifies actionable treatment options for about 20% of patients, so this testing can be genuinely important.

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TREATMENT STRATEGY & OPTIONS

3. What is the treatment intensification plan?

• According to current guidelines, treatment intensification (combination therapy) is now standard of care. What combination approach are you recommending for me specifically?
• Will this involve hormone therapy, chemotherapy, targeted drugs, immunotherapy, or a combination?

4. If I have hormone-sensitive metastatic disease, what's your first-line approach?

• Are you recommending androgen deprivation therapy (ADT) alone, or a combination with:
  • Chemotherapy (docetaxel)?
  • Potent androgen receptor blockers (abiraterone, apalutamide, enzalutamide)?
  • All three together (triplet therapy)?

Dr. [removed] Armstrong notes that "treatment intensification is now standard of care" and that "it's no longer standard of care to offer Lupron alone" to newly diagnosed metastatic patients.

5. If I have castrate-resistant disease, what options are available?

• Which of these approaches are you considering:
  • Androgen receptor degraders or blockers?
  • Chemotherapy (docetaxel, cabazitaxel)?
  • Immunotherapy (checkpoint inhibitors, cancer vaccines)?
  • Targeted therapies based on my genetic mutations?
  • Radiopharmaceuticals like Pluvicto (lutetium-177 PSMA)?

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IMAGING & MONITORING

6. What imaging will you use to monitor my disease?

• Will you use PSMA PET scans? (These are more sensitive than traditional scans for detecting prostate cancer spread)
• How often will I get scans, and what will you be looking for?
• How reliable is PSA as a marker for my specific situation? (PSA can be misleading in castrate-resistant disease)

7. Should I consider additional monitoring tests?

• Would circulating tumor DNA (ctDNA) testing help track my response to treatment?
• Are there other blood tests that would give us better information about how I'm responding?

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TREATMENT RESPONSE & SIDE EFFECTS

8. How will we know if treatment is working?

• What does "response" look like for my specific treatment plan?
• Will you be looking at PSA levels, scan changes, symptoms, or a combination?
• How long will we give a treatment before deciding if it's working?

9. What are the realistic side effects I should expect?

• What are the most common side effects with my specific treatment plan?
• Which side effects are manageable, and which ones might require stopping treatment?
• Are there supportive care options to help manage side effects?

10. What's the plan if my cancer becomes resistant to this treatment?

• What's our "next step" if this treatment stops working?
• Are there clinical trials I should know about?
• How many treatment options do we have available to us?

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QUALITY OF LIFE & WHOLE HEALTH

11. How should I approach lifestyle and overall health?

• What lifestyle factors (diet, exercise, stress management) might help my treatment work better?
• Should I be concerned about cardiovascular health, bone health, or other side effects?
• Are there mental health or support resources you recommend?

Dr. [removed] emphasizes that "whole health emphasis" is increasingly important—men with prostate cancer are living longer, and quality of life during treatment matters significantly.

12. What's your experience with my specific situation?

• How many patients like me have you treated?
• What outcomes have you seen with the treatment you're recommending?
• Are you connected with clinical trials or specialized centers for advanced prostate cancer?

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PRACTICAL CONSIDERATIONS

13. Are there clinical trials I should consider?

• Do you have access to clinical trials testing newer combinations or approaches?
• Would a second opinion from a specialized prostate cancer center be helpful?

14. How will we communicate about my care?

• How often will we meet to review progress?
• How can I reach you if I have concerns between appointments?
• Who else is on my care team?

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IMPORTANT CONTEXT

According to the CancerPatientLab webinars on prostate cancer, the field has changed dramatically in recent years. Treatment is now more personalized based on:

• Whether your cancer is hormone-sensitive or resistant
• Your specific genetic mutations
• Where your cancer has spread
• Your overall health and preferences

The webinar "Guiding Personalized Treatment for Advanced Prostate Cancer" emphasizes that "treatment intensification is now standard of care," meaning combination approaches are more common than single-drug treatments.

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BRINGING IT ALL TOGETHER

Consider asking: "Based on my specific situation—my cancer type, genetic testing, where it's spread, and my overall health—what's YOUR recommended treatment plan, and why do you think it's the best option for me?"

This helps your oncologist explain their clinical reasoning and ensures you understand the "why" behind their recommendations.

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