‘Why Me?’: How A Family Man Facing Advanced Prostate Cancer Is Overcoming The Fear– “You Have To Move Forward”

“He comes back and says it went to your bones — my sternum, my L4, my fifth rib — and I got pretty angry,” Douglas recalls.

Metastatic prostate cancer occurs when the disease leaves the prostate and spreads to other parts of the body, most commonly the bones of the axial skeleton, which includes areas like your spine, pelvis, and ribs.

Bone metastases can lead to pain, weakness, and difficulty with daily activities, and they can also affect overall health, but today, there are many treatment options.

Coming to terms with the reality of advanced cancer forced Douglas to reflect on the resilience he built throughout his life.

“I came from a very poor family, had nothing, went into the army, learned how to become disciplined,” he explains. That discipline became a foundation for how he would face cancer.

He also leaned on lessons from another major turning point: getting sober.

“I got sober for 35 years, and I learned in the groups it was important to share,” he says. “That helped me once, and I said, damn it, if it helped me then, it’s going to help me now.”

However, finding a support group wasn’t easy.

“I was amazed that they didn’t have one — not one!” Douglas says of his local hospital.

His experience echoes what many men with advanced prostate cancer face: isolation, fear, and the pressure to stay silent.

SurvivorNet has highlighted many of those stories in our film series, “Men Beating The Odds.” The films in the series tell stories of men confronting metastatic prostate cancer and redefining what survival looks like.

Douglas believes that pride often keeps men from seeking the help they need.

“Men are too hung up on the machismo. They have too much pride. They don’t want to talk about symptoms like erectile dysfunction, and I think that scares them,” he says.

He refused to let embarrassment hold him back.

“I wasn’t going to let it be embarrassing for me. I’ve been through too much to let that hold me down,” he says.

With the support of his wife and a commitment to taking things day by day, Douglas continues navigating life with metastatic prostate cancer.

His joints sometimes ache, and the road isn’t always smooth, but his perspective remains grounded.

“I had the ups and downs, and I’m going to have them. But… I’m alive,” Douglas says.

Today, he’s grateful for every day he gets to keep moving forward.

Diagnosing Advanced Prostate Cancer

Prostate cancer is typically diagnosed after a patient presents with an elevated prostate-specific antigen (PSA) level on a routine screening test or is experiencing symptoms.

“Most of the time, before [patients] are 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, tells SurvivorNet.

PSA, or prostate-specific antigen, is a protein produced by the prostate gland. Elevated levels may indicate inflammation, benign enlargement, or cancer, which is why PSA tests are part of the routine screening procedure. A digital rectal exam may also be performed to check the prostate for lumps.

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

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

If a doctor suspects prostate cancer based on PSA levels or symptoms, they will order a biopsy to confirm the diagnosis.

Once your biopsy is completed the doctor will send the tissue to another doctor called a pathologist to assess if the biopsy has cancer cells. In addition to determining if cancer is present, the pathologist will also assign a Gleason score to the cancer that tells your doctor how aggressive it is.

The Gleason score 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, 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.

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 may be used, such as:

• 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. 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 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.

• 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 the role of immunotherapy in prostate cancer treatment is not yet well-established.
• 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.

Surgery For Advanced Prostate Cancer

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.

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.

There are a few different surgical approaches that might be possible. 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.

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 either 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 explains.

Prostate Cancer Screening and Warning Signs

There is some debate about when men could begin screening for prostate cancer among major health organizations.

• The United States Preventive Services Taskforce (USPSTF) recommends that men between the ages of 55-69 discuss prostate cancer screening with their doctors and make a plan for regular evaluation.
• The American Cancer Society recommends that men at average risk begin screening at age 50. Men who are at high risk of prostate cancer should begin screening at age 40, and those with a close relative diagnosed with prostate cancer should consider annual screenings in their 30s.
• SurvivorNet experts suggest that men consider factors like their family history, genes, and age when deciding whether and when to screen.

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.

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 To Ask Your Doctor

If you have experienced symptoms associated with prostate cancer or have a screening coming up, consider asking your doctor the following:

• What else could be causing an elevated PSA 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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