What questions should I ask my oncologist about Prostate Cancer

Key Questions to Ask Your Prostate Cancer Oncologist

I'll organize these questions by topic to help you have a more productive conversation with your care team. These questions are based on current prostate cancer treatment approaches and what leading oncologists recommend patients understand.

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UNDERSTANDING YOUR DIAGNOSIS

About Your Cancer Type & Stage

1. What stage is my prostate cancer, and what does that mean for my treatment options?

   • Understanding whether your cancer is localized (confined to the prostate), metastatic (spread to other areas), castrate-sensitive (responsive to hormone therapy), or castrate-resistant (continues growing despite low testosterone) is fundamental to treatment planning.

2. Has my cancer spread beyond the prostate? If so, where?

   • According to the CancerPatientLab webinar on prostate cancer treatments, doctors use imaging like PSMA PET scans, CT scans, MRI, and bone scans to determine if cancer has spread to lymph nodes, bones, or other organs.

3. What is my Gleason score, and what does it tell us about my cancer's aggressiveness?

   • This scoring system (ranging from 6-10) helps predict how quickly your cancer may grow.

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TESTING & BIOMARKERS

Genetic & Molecular Testing

1. Should I have genetic testing done on my tumor tissue?

   • According to Dr. [removed] Armstrong's guidance on personalized prostate cancer treatment, most men in community practices aren't getting tested. Ask specifically about:
     • DNA sequencing to look for mutations like BRCA1/BRCA2, CDK12, and mismatch repair deficiency
     • RNA sequencing to identify gene expression patterns
     • These tests can identify actionable treatments for about 20% of patients

2. Should I have a liquid biopsy (blood test) to look for circulating tumor DNA?

   • Liquid biopsies can help monitor your disease over time and identify mutations without invasive tissue sampling.

3. What specific biomarkers are relevant to my cancer, and how will they guide treatment?

   • Examples include AR (androgen receptor) status, PSMA expression, VEGF pathway activation, and neuroendocrine markers.

Monitoring Tests

1. How will we monitor my PSA levels, and what PSA changes should concern us?

   • Important context: PSA can be tricky to interpret, especially in castrate-resistant prostate cancer. Ask how your doctor will use PSA alongside other markers.

2. What imaging tests will I need, and how often?

   • PSMA PET scans are increasingly used and can detect cancer earlier than traditional imaging.

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TREATMENT OPTIONS & STRATEGY

Understanding Your Treatment Plan

1. What are ALL my treatment options for my specific situation?

   • Treatment approaches vary significantly based on whether your cancer is hormone-sensitive or hormone-resistant, and whether it's localized or metastatic.

2. Why are you recommending THIS specific treatment over other options?

   • Ask your doctor to explain the clinical reasoning behind their recommendation.

3. Will my treatment involve combinations of drugs, or a single therapy?

   • According to current prostate cancer guidelines, treatment intensification (using combinations) is now standard of care and often produces better outcomes than single therapies.

Hormone Therapy Questions

1. If hormone therapy is recommended, how long will I take it, and what are the side effects?

   • Androgen deprivation therapy (ADT) can affect bone health, cardiovascular health, sexual function, and quality of life.

2. Are there newer androgen receptor inhibitors (like abiraterone, enzalutamide, apalutamide, or darolutamide) that might be appropriate for me?

   • These are increasingly used earlier in treatment.

Targeted & Precision Therapies

1. Based on my genetic testing, am I a candidate for PARP inhibitors?

   • If you have BRCA mutations or other DNA repair deficiencies, PARP inhibitors (like olaparib) combined with androgen receptor inhibitors may be effective.

2. Am I a candidate for immunotherapy, and if so, which type?

   • Options include:
     • Immune checkpoint inhibitors (like pembrolizumab/Keytruda) if you have mismatch repair deficiency
     • Sipuleucel-T (Provenge), a cancer vaccine for certain metastatic castrate-resistant prostate cancer patients
     • CAR-T cell therapy or T-cell bispecifics (emerging approaches)

3. Could I benefit from radiopharmaceuticals like Pluvicto (lutetium-177 PSMA)?

   • These are radioactive drugs that target PSMA-positive cancer cells. Ask if you're a candidate based on your PSMA PET scan results.

Combination Therapy

1. Would combining different types of treatment (hormone therapy + chemotherapy + radiation, for example) be more effective for me?
   • Research shows combinations often outperform single therapies.

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CLINICAL TRIALS

1. Are there clinical trials available for my specific cancer type and stage?

   • Ask about trials testing new combinations, immunotherapies, targeted drugs, or novel approaches.

2. What would be the benefits and risks of participating in a clinical trial versus standard treatment?

3. If I progress on my current treatment, what clinical trials might be available then?

   • This helps you plan ahead and understand future options.

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SIDE EFFECTS & QUALITY OF LIFE

1. What side effects should I expect from my treatment, and how can we manage them?

   • Different treatments have different side effect profiles. Understanding what to expect helps you prepare.

2. How will this treatment affect my sexual function, bone health, cardiovascular health, and overall quality of life?

   • According to Dr. [removed] Armstrong's guidance, there's increasing emphasis on "whole health" — mental health, cardiovascular health, bone health, and lifestyle factors all matter.

3. Are there lifestyle changes (diet, exercise, stress management) that could help my treatment work better?

   • Lifestyle factors contribute to disease aggressiveness and survival outcomes.

4. If I experience significant side effects, are there alternative treatments we could try?

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MONITORING & FOLLOW-UP

1. How will we know if my treatment is working?

   • Ask about the specific markers and tests your doctor will use (PSA, scans, symptoms, blood work).

2. How often will I have follow-up appointments and imaging?

3. What changes in my symptoms or test results should prompt me to contact you immediately?

4. If my cancer progresses or becomes resistant to my current treatment, what's our next plan?

   • Ask your doctor to outline a general strategy for future treatment lines so you understand the pathway ahead.

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BUILDING YOUR CARE TEAM

1. Should I see a medical oncologist who specializes in genitourinary (prostate) cancers?

   • Specialists often have more experience with complex cases and access to cutting-edge treatments.

2. Are there other specialists I should be working with (radiation oncologist, urologist, etc.)?

3. Can you help me access my complete [ID removed] and test results?

   • You have the right to your health data. Having copies helps you stay informed and can be valuable if you seek a second opinion.

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IMPORTANT CONTEXT FOR YOUR CONVERSATION

According to the CancerPatientLab webinars on prostate cancer:

• Treatment is increasingly personalized: Your specific genetic mutations, biomarkers, and disease characteristics should guide treatment selection, not just your stage.

• Get diverse testing: Rather than relying on a single test, comprehensive evaluation using multiple approaches (tissue testing, blood tests, imaging) provides a more complete picture.

• Plan ahead: Discuss not just your immediate treatment, but also what happens if your cancer becomes resistant. This helps you preserve treatment options for future use.

• Validate findings: If major treatment decisions are based on a single test result (especially RNA expression tests), ask about confirmation through other testing methods like immunohistochemistry (IHC) or proteomic tests.

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BRINGING IT ALL TOGETHER

Before your appointment, consider:

• Writing down your top 5-10 priority questions
• Bringing a trusted family member or friend to take notes
• Asking for written summaries of your treatment plan
• Requesting copies of all test results and