Is this going to kill me?

When a person hears they have cancer, the number one question often is whether or not the cancer will be deadly. Your doctor can give you a better idea of whether your prostate cancer is likely curable or if it is something that you will need to live with for the remainder of your life.

That opinion will be based on factors related to the cancer aggressiveness and your health. Prostate cancer aggressiveness is judged by the Gleason score, the PSA level, and whether the cancer is all in the prostate or has moved to lymph nodes, other organs, or bones.

In most cases, cancer that is all in the prostate is cancer that we hope can be cured. In many cases, cancer that has spread to bones or other organs is usually not curable. However, the details matter and only your doctor can really give you a good guess as to how things will go for you.

Remember that your doctor is always just making their best guess. No one knows exactly what will happen in the future, and cancer surprises even the most well-trained and experienced doctors. Just know that this is a really important question to ask for most patients, and you should not feel stressed or embarrassed if this is something that you want to know.

Also, know that many men with incurable prostate cancer live for years, and sometimes decades, with their cancer. So, no matter what the answer is, it is important to look to the future with optimism and resolve to live well, whether you are living with or after a diagnosis of prostate cancer.

Is there a cure?

It is important to ask your doctor whether your prostate cancer may be curable or not. The doctor’s opinion about whether the cancer may be curable or not is based on factors related to the cancer's aggressiveness.

Prostate cancer aggressiveness is judged by the Gleason score, the PSA level, and whether the cancer is all in the prostate or has moved to lymph nodes, other organs, or bones. In most cases, cancer that is all in the prostate is cancer that we hope can be cured.

In many cases, cancer that has spread to bones or other organs may not be curable. However, the details matter and only your doctor can really give you a good guess as to how things will go for you.

Is there anything we can do to treat metastatic prostate cancer?

Patients with metastatic prostate cancer can absolutely be treated, and in many cases, they can live for years. T

reatment for cancer that has spread outside of the prostate (metastasized) is usually medical therapy given by injection, pills, or infusion. In many cases, doctors use combinations of medical therapies to get the strongest effect against the cancer without causing many more symptoms for the patient (and in many cases improving symptoms for the patient!).

Besides using medicines directed at controlling the cancer, your doctor may recommend medicines for pain control, medicines to help your bowels keep moving, or medicines to help with hot flashes, or mood changes if these symptoms are affecting you.

Finally, doctors often recommend radiation treatment to the prostate gland or areas of prostate cancer in the bones that are causing pain in addition to medical therapies.

To know what the right combination is for you, you will need to talk with your doctor. But know that prostate cancer that has metastasized can be treated, and you can feel well, if not better, during treatment.

Am I going to be in pain?

Pain is one of the scariest things to think about when you have a diagnosis of cancer. Of all cancers, prostate cancer has a reputation for spreading to bones, which can be a cause of bone pain for some patients.

Although prostate cancer can cause pain, you should know that doctors have many ways to treat pain that can cause it to be well controlled so that you can live without being limited by pain.

In many cases, doctors can recommend targeted radiation to be given to areas in the bone where cancer is causing pain. This improves pain control for a majority of patients. In combination with this, or when radiation is not possible, doctors often recommend pain medications that can be very helpful in reducing pain. These medicines can be used on an as-needed basis, or if the pain is more severe, can be scheduled to be used two or three times a day around the clock with plans to take additional as-needed doses of pain medications if pain is worse at certain times.

It is helpful to remember that some of these medications can slow down the bowels and cause constipation, so please talk with your doctor about using medications or dietary measures to keep your bowels moving if you are taking medicines for pain control.

Will I be able to have sex during or after my treatment? Is it safe? Will it make the cancer worse?

Patients do not have to worry that having sex during treatment for prostate cancer will make the cancer worse.

In some cases, such as when patients are using chemotherapy, it is recommended that patients use condoms during sex to avoid having medications pass into the ejaculate and expose their partner.

Ask your doctor or pharmacist if this is a concern for you if you are using medicines to treat your cancer and want to have sex. Sex does not make the cancer worse, and can be a way for patients to connect with their partners and cope during a difficult diagnosis.

It is also important to know that many men do not feel like having sex during treatment for prostate cancer. If you do not want to have sex, remember that libido, or sex drive, is dependent on many factors and lack of libido is not your fault or unusual.

Understanding the cause of low libido can give you a starting point for changing things. Also, remember that medications that are used to treat prostate cancer decrease testosterone levels.

Testosterone is a male hormone that is largely responsible for libido and can support having good erections. If it is low, you may need to make a special effort to get yourself in the mood to have sex, and you may need medications or devices to help you have erections that can sustain intercourse. You can ask your team to refer you to a sexual health specialist or urologist who specializes in erectile dysfunction to help you with these concerns.

There are multiple things that you can do to support sexual health despite a prostate cancer diagnosis, and asking for help from your cancer treatment team is a great first step towards regaining this part of your life.

What does dying from prostate cancer look like?

Dying from prostate cancer usually entails having more and more fatigue and less energy. Patients spend more time in a chair or in bed and sleep more rather than being awake. Eventually, patients sleep all day and night, and at some point, they do not wake up and pass away.

As their body shuts down, a patient dying of prostate cancer has less of an appetite and eats less and less. This can alarm a patient’s family, and can cause arguments because the patient doesn’t want to eat (it makes them feel uncomfortable or turns their stomachs to think about food), but their family wants them to do everything they can to stay strong. As a person’s body is shutting down, losing appetite is normal. It is important to understand this and not fight over things that neither the patient nor the family has control over.

Some patients dying of prostate cancer have increased pain in the bones due to cancer growth, so using pain medications that are long-acting and don’t require someone to take them every 4-6 hours can be important, especially because patients sleep more and waking up to take medications can interrupt their rest. Pain medications can make people sleepier, so working with the healthcare team to make sure that there is a good balance between pain control and sleepiness is critical. Because pain medicines can also slow down the bowels, having medicines to help keep bowel movements regular is also important during this time.

People dying of prostate cancer can have these symptoms and others. Working with healthcare teams that specialize in treating symptoms of advanced cancer can be incredibly helpful for the patient and also for the family. These teams come by many names, including palliative care, hospice, pain management, and symptom management. Working with them can be one of the best ways to learn how to best take care of the symptoms of the patient and the needs of family members or loved ones during what can be a very stressful and painful time.

Is this going to make me feel or act like a woman? Will treatment make my penis and testicles shrink?

Medicines used to treat prostate cancer often decrease testosterone levels. This can cause things like hot flashes and mood changes or irritability like women may experience during menopause. This does not mean that you will feel or act like a woman. It just means that men who have changes in hormone levels go through things that are similar to when women have changes in hormone levels, like during menopause.

Aging men naturally have decreases in testosterone levels, so some patients getting this treatment do not feel these effects because their hormone levels are already low. These medications usually cause sex drive or libido to be very low, and they can cause patients to have trouble with erections. With ongoing exposure, these medications can also cause a decrease in penis length and size, and a shrinkage of the testicles.

Finally, some medications can also cause an increase in breast tissue over the pectoral muscles of the chest. This area can become tender. These changes may be reversible if the medicines are only being used for a short period, but they can be more permanent if treatment goes on for years. Exercise and lifestyle changes that limit weight gain can help prevent some of these effects, especially breast tissue enlargement.

None of the changes that happen with hormonal treatment make a prostate cancer patient turn into a woman. Talking with your doctor about what you are experiencing may be helpful as there may be ways to limit these changes.

I feel anxious and scared all the time - is there anything I can do?

It is common to feel anxious, scared, depressed, and sometimes angry after a cancer diagnosis. These feelings may pass relatively quickly over 3-6 weeks, or they may stick around for longer.

Changes in mood often come with changes in appetite and sleep, causing people to sleep or eat more or less. It is important to talk with your doctor and support network of loved ones and friends if you are feeling these things.

Some people find it helpful to talk about their feelings with support groups, family, friends, or other loved ones. For others talking with a psychologist can be a way to learn coping strategies and changes in perspective to get through difficult things like the ups and downs of a prostate cancer diagnosis.

There are also many medicines that can help you feel better by correcting the changes in the body that cause low mood in times of physical or emotional stress. These medicines take weeks to months to work because they allow the body to restore itself to normal rather than just being “happy pills.” Some people even use a combination of medicines and counseling to feel better.

Whatever works for you is worth it because you can feel better. Talk with your doctor to take the first steps to do that.

How can I do something to help treat my cancer on my own, without medications?

The most important thing that you can do on your own for your cancer is to try to eat a heart-healthy diet and stay physically active through exercise.

Diets that limit red meat and saturated fats, especially fried foods, and those that emphasize vegetables and fiber-rich greens can keep your body healthy and make you feel better.

Weight-bearing exercises help maintain your bone density, and exercises like walking also keep your heart and other muscles strong. Information on diet and lifestyle approaches to eating well and exercising with cancer can be found on the Prostate Cancer Foundation website.

Isn't the hormonal treatment worse than the disease? Is it even worth it?

Medical treatment for prostate cancer lowers testosterone levels and causes many changes that are not what we wish patients to experience, including hot flashes, mood changes, decreased sex drive or libido, erectile dysfunction, fatigue, weight gain, and others.

Despite this, these treatments are the most effective way to shut down prostate cancer cells to help patients live longer and prevent complications associated with cancer growth, including pain, broken bones, and even paralysis. Despite the side effects that come with treatment, most men feel better when the cancer cells are shut down by the medicines.

Most people also do not have every side effect listed. If you are experiencing side effects from hormonal therapy, you can ask your doctor to help you think through ways to make things better.

Most men gain more than they lose from treatment. It is important to remember that you can talk with your doctor about your side effects and talk over time about whether treatment still makes sense for you.