Green Health & Wellness Questions to Ask Your Doctor – GWC Mag gwcmagMarch 15, 2024023 views A diagnosis of prostate cancer can stir up fear and worry. That’s especially true when it’s metastatic, or stage 4, prostate cancer, meaning that it has spread from the prostate to other parts of the body. “The diagnosis of metastatic prostate cancer, or any cancer for that matter, is emotionally debilitating,” says Eleni Efstathiou, MD, PhD, a professor of medicine and chief of genitourinary medical oncology at Houston Methodist Neal Cancer Center in Texas. “We consider cancer to be the worst that can happen to us, and a lot of it has to do with stereotypes of older times where we didn’t have [effective] treatments.” Today, oncologists have many treatments to slow stage 4 prostate cancer. The more you know about your cancer and how your doctor will manage it, the less frightening it will seem. Whether you’ve just been diagnosed, or your cancer spread after treatment, here’s what to ask your doctor about metastatic prostate cancer. Where Has My Cancer Spread? This is one of the first questions to ask your oncologist about metastatic prostate cancer. Stage 4 prostate cancer manifests in different ways, says Dr. Efstathiou. It can range from cancer that has spread to only one or two places and is easy to treat, to tumors that have reached several organs, like the bones, lungs, and liver. Your doctor will have you undergo imaging scans such as a computerized tomography (CT) scan, bone scan, or MRI to see exactly where in the body your cancer has spread. Knowing where your cancer has spread will also help your doctor determine the best treatment option for you. [1] How Aggressive Is My Cancer? The answer to this question will help determine which treatment you receive. The most common way to get that answer is to determine your Gleason score, which is a grading system for prostate cancer that rates how aggressive your cancer is based on how your cancer cells look under a microscope. [2] The sample of cancer cells are taken during a prostate biopsy. A higher score, which means your cancer cells look more abnormal, indicates a more aggressive cancer, whereas a lower score suggests less aggressive tumors. Efstathiou adds that in general, prostate cancer that is first diagnosed at the advanced stage tends to be more aggressive than prostate cancer that comes back after treatment. Should I Get a Second Opinion? If you’ve just been diagnosed with metastatic prostate cancer, you have the right to a second opinion. [3] In fact, it’s encouraged. Each oncologist has their own treatment methods and style. Seeing two — or more — doctors will give you a better perspective on your options. Most insurance companies will cover the cost of a second opinion. Still, it’s a good idea to check with your insurance company before you make the appointment. What Are My Treatment Options? Options for treating metastatic prostate cancer include radiation therapy, hormone therapy, chemotherapy, targeted therapy, immunotherapy, and sometimes surgery. [4] Typically, the first treatment is hormone therapy with a combination of two drugs — one that blocks your body’s production of testosterone (a hormone that helps prostate cancer grow), and another that stops testosterone from getting into the cancer cells to fuel their growth, says Efstathiou. Which treatment or combination of treatments you get will also depend on your cancer’s location and genetic makeup. For example, if your prostate cancer has spread to the bones, radiation treatments that directly target bone problems may be considered. Or, if your cancer cells have a BRCA1 or BRCA2 gene mutation, you might get a type of targeted drug called a PARP inhibitor. This medication makes it harder for the cancer cells to repair their own DNA, which accelerates their death. [5] If your doctor doesn’t suggest genetic testing, ask for it, Efstathiou suggests. Your health is another consideration. If you have another serious medical condition like heart disease or diabetes, your doctor might recommend a treatment option different from that given to someone without those conditions. Learn About Treatment Options for Stage 4 Prostate Cancer What Side Effects Might I Experience From Treatment? The drop in testosterone levels from hormone therapy can cause side effects such as: [6] Each of the other treatments comes with potential side effects, too. Be sure to ask about the side effects associated with the specific treatments you will be given. How Can I Manage Side Effects? Not everyone who gets hormone therapy has side effects, says Efstathiou. If you do, your doctor has treatments or lifestyle recommendations to manage them. For example, antidepressants help with depression and hot flashes. Exercise can improve fatigue and weight gain. Do You Recommend a Clinical Trial? None of the prostate cancer treatments that are prolonging lives today would have been possible without clinical trials, says Efstathiou. These studies can give you access to new — and potentially more effective — cancer drugs. And you don’t have to wait until you’ve run out of treatments to enroll in a study. Ask your doctor whether you qualify for any trials of new therapies for metastatic prostate cancer. Before you enroll, make sure you understand what the therapy is expected to do and what side effects it might cause. What Lifestyle Changes Should I Make? Treating prostate cancer involves more than just medication. Lifestyle changes are important, too. For instance, obesity is linked to a higher risk of dying from prostate cancer. [7] Eating more fruits and vegetables and fewer saturated fats, exercising often, and losing weight if you’re overweight are all good strategies for staying healthy during your treatment. Don’t forget to manage your stress. “A lot of men come in already being type A personalities — stressful people with stressful lives. And then on top of it is the stress of [living with] cancer,” Efstathiou says. Staying active, practicing relaxation techniques like meditation and deep breathing, and seeing a mental health care provider if you feel overwhelmed, are all good stress-relief strategies. What’s My Outlook? This question is on the minds of many of Efstathiou’s patients. Your doctor can’t tell you exactly how long you’re going to survive with prostate cancer. That depends on a lot of factors, including the aggressiveness of your cancer, where it has spread, and how well it responds to treatment. You do have reason to be optimistic, though. Survival rates for metastatic prostate cancer are improving as new drugs come out. Instead of asking “How long will I live with prostate cancer?” men should ask, “What is going to be my quality of life?” Efstathiou says.