Prostate cancer patients — and their families — are being asked to make life-altering decisions based on protocols that often lag behind science, overlook nuance, and pretend complexity can be reduced to a flowchart. That’s why we need to get educated, not just informed. There’s a difference.

When a doctor says “ADT is the standard,” what they often mean is, “This is what we’ve always done.” But the biology of prostate cancer isn’t standard. It’s layered, unpredictable, and frequently resistant to the assumptions baked into many treatment pathways.

Why are we still treating every tumor like it responds the same way to hormone suppression, even when we know tumors can adapt — even thrive — in low-testosterone environments? Why are we not testing for androgen receptor activity before flipping the hormonal kill switch? Why do patients have to go digging through PubMed to understand what their care team hasn’t mentioned?

Because passivity can be dangerous.

Patients — especially those navigating advanced or recurrent disease — are not just recipients of care. They are collaborators in it. Or at least, they should be. The rise in testosterone post-RARP, the possibility of androgen-independent tumor clones, the very real psychological and cardiovascular toll of ADT — these are not abstract concerns. They are lived realities. They deserve more than a shrug and a standard-issue prescription.

So yes, we ask questions. We read the studies. We wonder whether the seeds hiding in lung tissue have mutated past testosterone dependency. We question the timing, the thresholds, the assumptions — not because we’re difficult, but because we’re awake.

If the professionals are truly committed to caring, they should welcome an informed patient. And if they don’t? Then it’s all the more reason we have to speak up. Before the side effects. Before the resistance. Before we’re told “this is just how it’s done.”

Because our lives — and our clarity — are on the line.