Questions I should have asked about prostate cancer, but did not

A cynical, slightly pissed-off handout for the newly diagnosed.

Congratulations ! You’ve joined the club no one wants to be in.
You’ve just heard the words “You have prostate cancer,” and now your urologist is talking at you like a malfunctioning PowerPoint presentation. You’re nodding, blinking slowly, trying to remember how breathing works—and suddenly you’re being booked for scans, shots, maybe surgery. I regret that I didn't, because I thought, "Who am I to discuss approach and strategies with a physician who does this for a living" ( I had no clue that recommendations of physicians also influence said physician's ability to pay his or her monthly mortgage)

This isn’t the time to be polite. This is the time to ask the uncomfortable, un-rosy, deeply cynical questions you should be asking. The ones that will actually help you make a decision you won’t regret when you’re lying awake at 3 a.m. wondering if this is your life now.

So here it is: the handout they should have given you. Full of uncomfortable truths and questions that pierce through the gauzy medical fog.

🧨 THE “OH S#!T” QUESTIONS
1. “How bad is this? Give me the version you tell your doctor friends at the bar.”
Skip the pamphlet language. What’s my actual risk of dying? Of permanent side effects? Of this turning into something fatal? I want straight talk, not curated optimism.

2. “What if I do nothing right now?”
What happens if I wait, monitor, or tell the cancer to take a number? Is this an emergency or just a really persistent squatter in my prostate?

3. “Are you suggesting this treatment because it’s best for me or because that’s just ‘what we do’?”
Am I a person or a protocol? Is this truly personalized medicine or a flowchart labeled “Gleason 7, age 67, slap with hormones”?

🔬 THE NITTY-GRITTY CANCER-NERD QUESTIONS
4. “What’s my Gleason score and what does it really mean?”
Especially if it’s 3+4=7 or 4+3=7. There’s a huge difference. One is “might be manageable,” and the other is “hold onto your butt.”

5. “What does the presence of cribriform pattern tell you?”
Cribriform = architectural chaos. It’s associated with more aggressive disease, poorer outcomes, and a higher risk of spreading. If I’ve got cribriform cells, I want to know if that changes the game plan from “moderate concern” to “get the nukes ready.”

6. “What about perineural invasion?”
That’s cancer cells getting cozy with the nerves. It’s like burglars figuring out the floorplan. It doesn’t always mean metastasis, but it sure makes you wonder if this thing is already scouting for exits. Ask if this increases your risk and if it changes treatment recommendations.

7. “Should we be doing genetic profiling of my tumor?”
If your doctor shrugs, ask again. There are tests (like Decipher, Prolaris, Oncotype DX) that assess how aggressive your tumor really is. They might tell you whether you need the full medieval treatment—or not.

Also, ask if you should be tested for germline mutations (BRCA1, BRCA2, ATM, etc.), especially if you have a family history of prostate, breast, ovarian, or pancreatic cancer. Some mutations = more aggressive cancer and possibly different treatment.

💀 THE “DOES THIS MAKE ME A ZOMBIE?” QUESTIONS
8. “What happens to my quality of life after this?”
And don’t you dare sugarcoat it. Will I still want sex? Will I be able to have sex? Will I feel like myself? Will I lose muscle mass, confidence, sleep, or the will to live?

9. “Will I regret this in a year?”
Ask to speak with patients who’ve gone through the same treatment. Preferably ones who aren’t on the clinic brochure. You want the raw version, not the testimonial from “Steve, 68, who hikes every day and glows.”

💰 THE CYNICAL CAPITALIST QUESTIONS
10. “Who profits from this decision?”
No, really. Is this radiation center owned by the same group making the treatment decisions? Is someone getting a kickback if I go on certain meds? If you think that’s paranoid, congratulations—you’re finally thinking like a patient who understands the system.

🧩 THE “WHO’S STEERING THIS SHIP?” QUESTIONS
11. “Do I have a case manager, navigator, or a human being who understands how lost I am?”
Because, guess what—oncology is a maze of specialists, insurance traps, and vague assurances. Get someone who can help you herd the cats.

12. “Can we build a treatment team that includes a cardiologist, urologist, oncologist, and maybe a damn therapist?”
Especially if you’ve got preexisting health issues (like, say, a heart condition) and are now being handed hormone therapy like it’s candy. These meds mess with more than your testosterone—they mess with your heart, bones, brain, and metabolism.

🛠️ BONUS: RED FLAGS TO WATCH FOR
Any doctor who says, “Don’t worry, you’ll be fine” without backing it up with actual data.

Anyone who brushes off your concerns about side effects like they’re quaint little inconveniences.

Being told you “don’t need to know” about genomic testing or tumor markers. You do.

One-size-fits-all treatment plans that sound suspiciously like conveyor belts.

FINAL WORDS FROM A GRIZZLED VETERAN OF THE PROSTATE WARS
If I could go back to Day One, I’d have brought this list, a tape recorder, and a friend who doesn’t let people off the hook. I’d have asked tougher questions, made fewer assumptions, and treated every recommendation like a used car deal: with skepticism, curiosity, and a readiness to walk away.

Because this is your body, your life, and your future. Everyone else? They go home after your appointment. You’re the one who lives with the consequences.

So ask the damn questions.