Facing Prostate Cancer, What Will My Care Team Look Like?

Metastatic prostate cancer means that the cancer has spread beyond the prostate to other parts of the body, most commonly to the bones, lymph nodes, lungs, or liver. While it is an advanced diagnosis, there are many treatment options available today — and your medical support team can help you sift through them.

Your Care Team

Your care team will involve different types of specialists, Dr. Gomella explains. Exactly which specialists will depend a lot on your unique situation and your treatment path.

Your team might include a:

• Urologist
• Radiation oncologist
• Medical oncologist
• Clinical trial support team
• Genetic counselor
• Nurse practitioner/physician’s assistant

Treatment Options

While metastatic prostate cancer is not usually curable, many treatments can help control the disease, relieve symptoms, and improve quality of life. Treatment is tailored to your specific case — as is your medical team.

The most common treatments for advanced prostate cancer include:

1. Hormone Therapy (Androgen Deprivation Therapy – ADT): Testosterone fuels prostate cancer growth. ADT lowers or blocks testosterone. This treatment can be done with injections (e.g., leuprolide) or surgery to remove the testicles, though the surgical approach is used more rarely today. This is frequently the first approach for metastatic disease.
2. Advanced Hormonal Therapies: These drugs block androgen receptors or further suppress testosterone production. They include abiraterone (Zytiga), enzalutamide (Xtandi), apalutamide (Erleada), darolutamide (Nubeqa).
3. Chemotherapy: Chemotherapy is usually given with a drug called docetaxel, sometimes followed by cabazitaxel. It can shrink tumors and improve survival, especially in men with widespread disease.
4. Radiation Therapy: This is used to relieve pain from bone metastases or control a limited number of metastases. In select cases, radiation to the prostate itself can benefit men with newly diagnosed metastatic cancer.
5. Bone-Targeted Therapies: Bisphosphonates or denosumab help prevent bone fractures and reduce pain. This approach is important if cancer has spread to the bones.
6. Targeted Therapy & Immunotherapy: PARP inhibitors (like olaparib) can sometimes be used for men with BRCA mutations or other DNA repair gene changes. Immunotherapy (like pembrolizumab) is used in select cases with specific tumor features.
7. Clinical Trials: Clinical trials can offer patients the opportunity to access groundbreaking new drugs that are still in the research phase (not yet federally approved).

Seeking Support

Your care team can include other professionals who can help you organize your treatment plan, care for your mental health, and more.

Nurse navigators, for example, can help coordinate care, manage side effects, and provide education. They can be a key point of contact when you have questions or concerns.

A social worker can offer emotional support and help with practical issues like transportation or insurance.

Each person on your team brings something important. Together, they’ll help you make informed decisions and live well with cancer.

Questions To Ask Your Doctor

• What are my treatment options?
• Who is my point person if I’m experiencing difficult side effects?
• How will treatment affect my daily life?
• Are there clinical trials I should consider?
• How do I manage pain or fatigue?

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