Questions for the Oncologist

Don’t know your biopsy results, need more info. Which oncologist: medication or radiation?

Medication or radiation? You mean there is two radiologists? Meaning if I go to a med one he/she most likely will not do radiation and vice versa? Oh crap, my biopsy show 4 out of 5 PC G9, my Pet scan show bone and two lymph nodes

Zzotte

Age is a factor in deciding on treatment. If you are under 70 (some say under 75), you may choose surgery. I am 68, surgery (RARP) was my first choice but after considering my family's concerns/worries about surgery, and doing more readings, in the end I had 5-fraction SBRT this April. Each of us will make the choice that we think is best for us and our family,

Because His cancer has spread to the bone and lymph nodes then surgery may not be The best option.

The metastasis he has on bone Can be zapped with SBRT, As can lymph nodes usually.

The fact that he’s a Gleason nine makes this very aggressive, some things you don’t mention. Did his biopsy show any of these issues cribriform, intraductal or seminal vesicle invasion? If so, the cancer is much more aggressive.Find out the answer to that, What else was in the biopsy?

Ask the doctor about having SBRT done, Also ask about whether that’s the best way to treat the prostate. If your cancer has already spread to lymph nodes, you may want to have the prostate radiated with SBRT And then the prostate bed radiated for 20 or so sessions with IMRT. Just doing surgery may not get the lymph nodes, and the bone metastasis, So no matter what he’s going to have more than one treatment.

My main advice is to bring a note-taker with you. My spouse was with me for my first 2 meetings with the radiation oncologist, and I can't express how important her notes were to me.

For your specific cancer situation, here are some talking points:

1. Be very clear about your preferences. If you want to hit the cancer hard and fight it, tell them; if you prefer to focus on quality of life and minimising side effects, tell them. Repeat yourself, and maybe even ask them to write it in your chart so that other doctors later see it.

(The rest are for if you choose aggressive treatment.)

2. Confirm that the cancer is oligometastatic.

(If it is oligometastatic…)

3. Ask about getting radiation to each of the individual metastases per the STOMP trial findings.

4. Ask about getting a high "curative" dose of radiation to the prostate, per the STAMPEDE trial findings.

5. Ask about starting on Apalutamide together with ADT right away, per the TITAN trial findings (they might suggest another -lutamide, and that's also good).

They may have good reasons for not doing any or all of these things, but it's important to ask the questions and have them explain their answers.

In particular, if they want to start you on Abiraterone acetate (Zytiga) instead of one of the modern -lutamides, confirm that it's for medical rather than insurance reasons (some U.S. insurance companies will try to push you to the older Abiraterone acetate just because it's out of patent and available in cheaper generic versions).

This is a lot to cope with all at once. Best of luck!

By “oncologist” do you mean “radiation oncologist” or “medical oncologist”?

zzotte, three: Medical oncologist, Radiation oncologist and Surgical oncologist. It does sound like radiation because of the nodes and bones, and probably anti-testosterone therapy. It is a bit of a panic at first. Best luck.

Just to confirm, they assigned me directly to a radiation oncologist with my bone metastasis, but they did still send in a medical oncologist once just to consult with me.

Prostatectomy isn't usually on the table for metastatic cancer, though, as I mentioned earlier, STAMPEDE did still show the value of radiating the primary cancer in the prostate as well as the metastases