Texas Bodybuilder, 50, Tests His Limits as He Trains for Upcoming Competition Even as Stage 4 Prostate Cancer Treatment Drains His Testosterone, a Building Block for Muscle Growth

 

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Years into his metastatic prostate cancer treatment, Thomas, a father of one, is fighting to reclaim the physique and discipline of his bodybuilding prime. But this comeback is tougher than any barbell he’s ever lifted.

His cancer treatment drains testosterone, which is the very hormone that fuels muscle growth, because it can also fuel prostate cancer.

“Metastatic disease is essentially prostate cancer that has left the prostate and traveled elsewhere in the body, whether it’s to lymph nodes or to the bone, which are the most common sites of metastatic spread,” says Dr. Vivek Narayan, a medical oncologist at the University of Pennsylvania.

“For the vast majority of patients with metastatic prostate cancer, the fundamental treatment approach is androgen deprivation therapy, or ADT,” Dr. Narayan added.

Often called hormone therapy, ADT is the backbone of treatment for advanced prostate cancer. It works by suppressing androgens — especially testosterone — which play a central role in driving the cancer’s growth.

“Androgens serve many important bodily functions,” Dr. Narayan explains.

“But circulating androgens can also act as a fuel source for the growth, development, and spread of prostate cancer.”

 

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By lowering these hormones, ADT can dramatically slow the disease’s progression. But for Thomas, it also makes rebuilding a body that depends on testosterone an uphill battle.

Still, he’s determined.

“I wanted to get back on stage,” he told WFAA. “That was where my heart was. The sport. Bodybuilding.”

“I know it’ll be tough, but I’ll find a way.”

His next competition is in early fall. That means the summer ahead will be spent sculpting his body as much as treatment allows.

The Benefits of Androgen Deprivation Therapy

ADT can often help:

• Lower PSA levels
• Shrink tumors
• Relieve symptoms

PSA, or prostate-specific antigen, is a tumor marker used to monitor the disease’s activity. A drop in PSA often signals that the therapy is working.

“When you start something like androgen deprivation therapy, that PSA number typically will go down. It can go down quite significantly, even sometimes approaching zero or undetectable levels,” Dr. Narayan explains.

When patients have large tumors, ADT can help shrink them in size, he adds.

Hormone therapy can also help symptoms associated with the disease, such as skeletal pain or urinary issues.

 

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“Upon initiating hormonal therapy and achieving this response, oftentimes those symptoms of the disease itself can be alleviated,” Dr. Narayan says.

“We know that androgen deprivation therapy (ADT) alone, or lowering a man’s hormone levels through either shots or pills, are usually not enough to give them a long-term remission,”  Dr. Leonard Gomella, Chair of the Urology Department at Thomas Jefferson University’s Sidney Kimmel Comprehensive Cancer Center, tells SurvivorNet.

“We’ll usually add something else, such as a pill on top of the androgen deprivation therapy (ADT) to further weaken the cancer and improve a man’s outcome,” he adds.

While not curative, hormonal therapy remains an important treatment option for metastatic prostate cancer management.

Weighing Benefits vs. Long-Term Impacts

Patients facing prostate cancer may think of hormone therapy as the only option, assuming that once it’s started, it continues without pause. But Dr. William Tester, professor of medical oncology at Thomas Jefferson University’s Sidney Kimmel Cancer Center, tells SurvivorNet that, as survivorship increases and treatment protocols evolve, the importance of reevaluating its impact across various stages of patient health grows.

“Times have changed,” Dr. Tester says. “I’m open-minded enough to realize the consequences of this type of treatment on men’s mental health, physical health, sexual health, cardiovascular health, and bone and muscle health. So, we really are dealing with the consequences of therapy and ways to try to mitigate that.”

WATCH: Are the Side Effects of Androgen Deprivation Therapy Worth the Risk?

Personalized medicine is an important component of finding the right treatment. Dr. Tester emphasizes that no two patients respond — or prioritize — their wellness in quite the same way.

While some men are deeply focused on preserving sexual function, others are concerned about bone strength or cardiovascular risks. It is a balancing act grounded in conversation and guided by lifestyle changes.

“Different men will view things quite differently,” Dr. Tester says. “We talk about taking care of your bones, your muscles, and some lifestyle changes. Exercise and weight training, I think, are important for men when they start ADT, and we kind of work through it as we go.”

Diagnosing Advanced Prostate Cancer

“So what if a patient comes in and they have an elevated PSA? Most of the time, before they’re referred to medical oncology or urology, they will have a primary care doctor, who will check their PSA level to see if it is high or above the normal range,” Dr. Neha Maithel, medical oncologist at UT Cancer Center in Houston, explains to SurvivorNet.

PSA, or prostate-specific antigen, is a protein produced by the prostate gland. Elevated levels may indicate inflammation, benign enlargement, or cancer — but they’re not definitive on their own. A digital rectal exam may also be performed to check your prostate health.

WATCH: If You Have a Family History of Prostate Cancer, Get Screened Early

If PSA levels are normal and no symptoms — such as urinary retention, painful urination, or blood in the urine — are present, patients typically continue with routine screenings.

There’s no single “normal” PSA level, but generally:

• PSA under 4.0 ng/mL is considered low
• PSA between 4-10 ng/mL is borderline
• PSA above 10 ng/mL is more concerning for cancer

“We have many new imaging technologies today,” Dr. Gomella said. “We have radiologic studies such as a CT scan and an MRI.

“One of the newer ones that’s out there is something called the PSMA scan, which is a nuclear medicine scan that is actually able to pick up spots of cancer that you may not see on a regular study, such as an MRI or CT scan,” he adds.

“Once they get a prostate biopsy, a pathologist looks at that biopsy specimen under the microscope to see what their Gleason score is,” Dr. Maithel explains.

The Gleason score is a critical tool for assessing the cancer’s aggressiveness. It ranges from 6 (least aggressive) to 10 (most aggressive), based on how abnormal the cancer cells appear and how they’re arranged.

This score helps oncologists determine whether the cancer is likely to grow slowly or spread quickly — information that directly influences treatment planning.

Once the Gleason score is established, doctors need to know whether the cancer is confined to the prostate or has spread beyond the prostate, also called metastasis.

“About five to seven percent of prostate cancer patients present with metastatic disease,” Dr. Maithel notes. “Metastatic disease means that the cancer has left the prostate gland itself and has spread to other areas — specifically, the prostate cancer likes to go to lymph nodes, bones, or the lungs.”

Metastatic Prostate Cancer Treatment

For most men, hormonal therapy (androgen deprivation therapy) is the starting point.

Hormone Therapy (Androgen Deprivation Therapy or ADT)

As noted earlier, androgen deprivation therapy reduces or blocks testosterone, slowing down the growth of cancer or even shrinking it. ADT does not cure prostate cancer, but it is very effective at controlling it, especially when the disease is more aggressive or has spread beyond the prostate.

In some cases, additional treatments are added to control the disease.

Hormone levels may be lowered through:

• Injections or implants that stop testosterone production
• Pills that block testosterone from attaching to cancer cells
• Surgical removal of the testicles (this is less common today)

ADT often works well for years, but cancer can eventually adapt, leading to castration-resistant prostate cancer (CRPC). When that happens, additional treatments are used.

• Androgen Receptor Pathway Inhibitor (ARPI) Hormonal Agents

Drugs like abiraterone, enzalutamide, apalutamide, and darolutamide can further block androgen production or signaling, even after standard hormone therapy stops working.

“There are new, advanced hormonal therapies which are often combined with the traditional hormonal therapies,” Dr. Daniel Hamstra, chair of radiation oncology at Baylor College of Medicine, tells SurvivorNet.

“These are called androgen receptor blockers or ARPIs, and these can provide a more effective treatment, either in the castrate resistant setting or, frankly, in the castrate sensitive setting as well.”

Indeed, in current practice, androgen receptor pathway inhibitors are commonly used in combination with traditional testosterone-lowering ADT for the majority of patients upon initial diagnosis of a metastatic prostate cancer.

• Chemotherapy

Medications like docetaxel or cabazitaxel target fast-growing cancer cells throughout the body. For some patients with advanced prostate cancer, chemotherapy can shrink tumors, ease symptoms, and improve survival. We’ll do a deeper dive into this further down.

• Targeted Therapy

If genetic testing of your cancer reveals certain mutations (for example, BRCA1/2), drugs like PARP inhibitors (olaparib, talazoparib, niraparib, rucaparib) may be effective.

• Immunotherapy

Some men with specific tumor markers (such as mismatch repair deficiency) may benefit from immune checkpoint inhibitors, which help the body’s immune system attack cancer, though Dr. Hamstra notes that the role of immunotherapy in prostate cancer treatment is not yet well-established.

“Immune therapy has not played a huge role in prostate cancer at this point in time, but it is potentially something that may become more relevant,” he explains.

• Radiopharmaceuticals

These are radioactive medicines injected into the bloodstream that travel to metastatic sites and deliver targeted radiation, such as radium-223 or lutetium-177 PSMA therapy.

• Radiation Therapy for Symptom Control

External beam radiation can be directed at bone metastases or other symptomatic sites to relieve pain or prevent fractures.

• Clinical Trials

Participating in a research study can give access to cutting-edge treatments not yet widely available.

More on Chemo and Metastatic Prostate Cancer

“Chemotherapy definitely has a place in the treatment of many men with metastatic prostate cancer,” Dr. Narayan said.

Dr. Narayan emphasizes that “not all chemotherapy is the same” and the type of chemotherapy used for prostate cancer is often better tolerated than the regimens used for other cancers, such as breast or lung cancer.

WATCH: Chemotherapy in Metastatic Prostate Cancer

“The chemotherapies that we conventionally use for prostate cancer can actually be better tolerated than some of the chemotherapies people may be familiar with. For example, the treatment of breast cancer, lung cancer, lymphomas, or other diseases that use a lot of chemotherapy,” Dr. Narayan said.

Since chemotherapy in prostate cancer tends to be better tolerated, Dr. Narayan says even older patients can often receive chemotherapy safely and effectively.

“We certainly have patients with prostate cancer, even in the older ages, seventies and even eighties, who we successfully give chemotherapy to. So, it can be done. There is a trade-off.”

When Is Surgery Used For Advanced Prostate Cancer? What Patients Should Know

For many men facing an advanced diagnosis, surgery will not be part of the treatment plan; however, there are certain situations where it can be beneficial.

Dr. Randall Lee, a urologic Oncologist at Fox Chase Cancer Center, says the possibility of surgery “depends on the patient, and it requires a lot of discussion and counseling.”

If the prostate cancer has only spread to a few spots — or what doctors call oligometastatic disease — androgen deprivation therapy, along with local radiation therapy, is typically the first choice for control.

WATCH: When Is Surgery Used For Advanced Prostate Cancer?

However, if the patient is dealing with urinary blockage or if the cancer is locally advanced but hasn’t spread to the lymph nodes, Dr. Lee points out that surgery could be an option for some of these patients.

Weighing Risks & Benefits

Surgery in advanced prostate cancer isn’t always straightforward. There can be side effects and risks from anesthesia, and it’s important to weigh how the procedure might affect your quality of life while still keeping the cancer in check. That’s why doctors take extra care in deciding who’s a good fit for surgery.

“In the appropriately selected patient that is counseled on the risks and benefits of surgery… it is possible, and it’s definitely something that is offered,” Dr. Lee explains.

When it comes to prostate cancer surgery, there’s no one-size-fits-all approach. One option is a prostatectomy, where the surgeon removes the entire prostate along with some surrounding tissue, including the seminal vesicles (they help produce semen).

This procedure is usually considered for patients whose cancer hasn’t spread beyond the prostate.

It’s important to know that a prostatectomy can come with side effects, like erectile dysfunction or urinary incontinence, which is why doctors weigh the pros and cons carefully before recommending it.

WATCH: Preparing For Prostate Cancer Surgery: Before, During & After

It can be performed using two primary approaches: open radical prostatectomy or minimally invasive (robot-assisted laparoscopic) prostatectomy.

While both robotic and open prostatectomy can offer excellent cancer control, robotic-assisted surgery has emerged as the preferred method for its potential advantages in recovery time, pain, and preservation of urinary and sexual function.

Surgery also doesn’t always mean removing the whole prostate. In some cases, especially for patients dealing with urinary issues or going through radiation, doctors might suggest procedures similar to those used for BPH (benign prostatic hyperplasia) — that’s when the prostate is enlarged. These surgeries help open up the urinary tract.

“There are surgeries in which we are able to open up the urinary tract to allow patients to have a better quality of life so they don’t run into issues after radiation or during radiation,” Dr. Lee explained.

If you’re facing advanced prostate cancer, the most important thing is to talk openly with your care team. Don’t hesitate to ask about all your options—including whether surgery makes sense for you. And make sure your personal concerns, like how treatment might affect your urinary symptoms, sex life, or your long-term quality of life, are part of that conversation.

Understanding Prostate Cancer Recurrence

Prostate cancer recurrence is not all that uncommon. A study published in the medical journal JAMA followed 1,997 men who had undergone prostate removal surgery. Of those, 304 experienced a recurrence, and about 25% of those cases occurred five or more years after surgery.

Researchers believe that dormant cancer cells can hide in the body for years. The bone marrow, in particular, is considered a key hiding place.

This is supported by findings published in the International Journal of Cancer, which noted, “In one autopsy study, approximately 80% of the men who had died from prostate cancer possessed bone metastases.”

Other potential reservoirs for dormant cancer cells include the lymph nodes and the prostate bed—the area where the prostate gland once was—though these are more difficult to study.

Researchers have made significant strides in understanding how prostate cancer can spread early—even when it appears to be under control—and then return months or even years later.

One key discovery is that the bones are a common site for prostate cancer to spread. In fact, scientists have found dormant cancer cells hiding in the bone marrow of many patients, even when the disease seems confined to the prostate.

Lab studies, mostly using model systems, have also helped uncover how prostate cancer cells can lie dormant for long periods before becoming active again.

While treatments like hormone therapy and radiation after surgery have shown promise, experts agree that more research—both in the lab and in clinical trials—is needed to improve outcomes for patients.

Prostate Cancer Screening and Warning Signs

When you do get screened for prostate cancer, your doctor will run a few tests.

One of the tests is the PSA test, a simple blood test that screens for prostate cancer. It looks for more significant amounts of protein-specific antigen (PSA) in the blood. An elevated PSA test does not always mean you have prostate cancer.

It could also reflect that your prostate is enlarged, which is common, or it could signal an infection or inflammation.

Your doctor may also conduct a digital rectal exam (DRE) to check your prostate for lumps.

Depending on the results of these tests, imaging scans and a biopsy may be ordered.

WATCH: How Gleason Grade Determines Treatment

Prostate cancer does not always behave the same in every man it impacts.

The cancer can be considered “low-risk” and can be slow-growing, and treatment might not be necessary. In other men, the cancer may grow faster or more aggressively, requiring more immediate treatment. Because of this, there is some debate about screening.

The United States Preventive Services Task Force recommends that men at average risk between the ages of 55 and 69 years talk with their doctor about the pros and cons of prostate cancer screening.

The American Cancer Society recommends that men at age 50 who are at average risk should begin screening. Men who are at high risk of prostate cancer should begin screening at age 40. Men with a close relative diagnosed with prostate cancer should consider annual screenings in their 30s.

SurvivorNet experts suggested that men consider factors like their family history, genes, and age when deciding whether and when to screen.

Symptoms of prostate cancer may include:

• Urinating more often
• Waking up in the middle of the night to pee
• Blood in your urine
• Trouble getting an erection
• Pain or burning when you urinate
• Pain in your back, hips, thighs, or other bones
• Unexplained weight loss
• Fatigue

Questions for Your Doctor

If you have experienced symptoms associated with prostate cancer or have a screening coming up, here are some questions you may ask your doctor:

• If I had elevated PSA levels, what could be causing that besides cancer?
• How long will it take to learn if my PSA levels warrant further testing?
• What are the treatment options that are best suited for me based on my risk level?
• What financial resources exist to help me with the costs associated with treatment?
• How long will my potential treatment prevent me from working or continuing normal activities?

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