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For 50\u2011year\u2011old Nazareth \u201cNaz\u201d Thomas, the gym wasn\u2019t a hobby; it was his home away from home as a bodybuilder. Then came the blow that threatened to take it all away: advanced prostate cancer already spreading through his body.<\/p>\n
According<\/a> to his GoFundMe, the cancer spread to his right femur, ribs, and lymph nodes.<\/p>\n Years into his metastatic prostate cancer treatment, Thomas, a father of one, is fighting to reclaim the physique and discipline of his bodybuilding prime. But this comeback is tougher than any barbell he\u2019s ever lifted.<\/p>\n His cancer treatment drains testosterone, which is the very hormone that fuels muscle growth, because it can also fuel prostate cancer.<\/p>\n \u201cMetastatic disease is essentially prostate cancer that has left the prostate and traveled elsewhere in the body, whether it\u2019s to lymph nodes or to the bone, which are the most common sites of metastatic spread,\u201d says Dr. Vivek Narayan<\/a>, a medical oncologist at the University of Pennsylvania.<\/p>\n \u201cFor the vast majority of patients with metastatic prostate cancer, the fundamental treatment approach is androgen deprivation therapy<\/a>, or ADT,\u201d Dr. Narayan added.<\/p>\n Often called hormone therapy, ADT is the backbone of treatment for advanced prostate cancer. It works by suppressing androgens \u2014 especially testosterone \u2014 which play a central role in driving the cancer\u2019s growth.<\/p>\n \u201cAndrogens serve many important bodily functions,\u201d Dr. Narayan explains.<\/p>\n \u201cBut circulating androgens can also act as a fuel source for the growth, development, and spread of prostate cancer.\u201d<\/p>\n By lowering these hormones, ADT can dramatically slow the disease\u2019s progression. But for Thomas, it also makes rebuilding a body that depends on testosterone an uphill battle.<\/p>\n Still, he\u2019s determined.<\/p>\n \u201cI wanted to get back on stage,\u201d he told<\/a> WFAA. \u201cThat was where my heart was. The sport. Bodybuilding.\u201d<\/p>\n \u201cI know it\u2019ll be tough, but I\u2019ll find a way.\u201d<\/p>\n His next competition is in early fall. That means the summer ahead will be spent sculpting his body as much as treatment allows.<\/p>\n ADT can often help:<\/p>\n PSA, or prostate-specific antigen, is a tumor marker used to monitor the disease\u2019s activity. A drop in PSA often signals that the therapy is working.<\/p>\n \u201cWhen you start something like androgen deprivation therapy, that PSA number typically will go down. It can go down quite significantly, even sometimes approaching zero or undetectable levels,\u201d Dr. Narayan explains.<\/p>\n When patients have large tumors, ADT can help shrink them in size, he adds.<\/p>\n Hormone therapy can also help symptoms associated with the disease, such as skeletal pain or urinary issues.<\/p>\n \u201cUpon initiating hormonal therapy and achieving this response, oftentimes those symptoms of the disease itself can be alleviated,\u201d Dr. Narayan says.<\/p>\n \u201cWe know that androgen deprivation therapy (ADT) alone, or lowering a man\u2019s hormone levels through either shots or pills, are usually not enough to give them a long-term remission,\u201d \u00a0Dr. Leonard Gomella<\/a>, Chair of the Urology Department at Thomas Jefferson University\u2019s Sidney Kimmel Comprehensive Cancer Center, tells SurvivorNet.<\/p>\n \u201cWe\u2019ll usually add something else, such as a pill on top of the androgen deprivation therapy (ADT) to further weaken the cancer and improve a man\u2019s outcome,\u201d he adds.<\/p>\n While not curative, hormonal therapy remains an important treatment option for metastatic prostate cancer management.<\/p>\n Patients facing prostate cancer may think of hormone therapy as the only option, assuming that once it\u2019s started, it continues without pause. But Dr. William Tester<\/a>, professor of medical oncology at Thomas Jefferson University\u2019s Sidney Kimmel Cancer Center, tells SurvivorNet that, as survivorship increases and treatment protocols evolve, the importance of reevaluating its impact across various stages of patient health grows.<\/p>\n \u201cTimes have changed,\u201d Dr. Tester says. \u201cI\u2019m open-minded enough to realize the consequences of this type of treatment on men\u2019s mental health, physical health, sexual health, cardiovascular health, and bone and muscle health. So, we really are dealing with the consequences of therapy and ways to try to mitigate that.\u201d<\/p>\n WATCH: Are the Side Effects of Androgen Deprivation Therapy Worth the Risk?<\/strong><\/em><\/p>\n Personalized medicine is an important component of finding the right treatment. Dr. Tester emphasizes that no two patients respond \u2014 or prioritize \u2014 their wellness in quite the same way.<\/p>\n While some men are deeply focused on preserving sexual function, others are concerned about bone strength or cardiovascular risks. It is a balancing act grounded in conversation and guided by lifestyle changes.<\/p>\n \u201cDifferent men will view things quite differently,\u201d Dr. Tester says. \u201cWe talk about taking care of your bones, your muscles, and some lifestyle changes. Exercise and weight training, I think, are important for men when they start ADT, and we kind of work through it as we go.\u201d<\/p>\n \u201cSo what if a patient comes in and they have an elevated PSA? Most of the time, before they\u2019re 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,\u201d Dr. Neha Maithel<\/a>, medical oncologist at UT Cancer Center in Houston, explains to SurvivorNet.<\/p>\n PSA, or prostate-specific antigen, is a protein produced by the prostate gland. Elevated levels may indicate inflammation, benign enlargement, or cancer \u2014 but they\u2019re not definitive on their own. A digital rectal exam may also be performed to check your prostate health.<\/p>\n WATCH: If You Have a Family History of Prostate Cancer, Get Screened Early<\/strong><\/em><\/p>\n If PSA levels are normal and no symptoms \u2014 such as urinary retention, painful urination, or blood in the urine \u2014 are present, patients typically continue with routine screenings.<\/p>\n There\u2019s no single \u201cnormal\u201d PSA level, but generally:<\/p>\n \u201cWe have many new imaging technologies today,\u201d Dr. Gomella said. \u201cWe have radiologic studies such as a CT scan and an MRI.<\/p>\n \u201cOne of the newer ones that\u2019s out there is something called the PSMA scan, which is a nuclear medicine scan that is actually able to pick up spots of cancer that you may not see on a regular study, such as an MRI or CT scan,\u201d he adds.<\/p>\n \u201cOnce they get a prostate biopsy, a pathologist looks at that biopsy specimen under the microscope to see what their Gleason score is,\u201d Dr. Maithel explains.<\/p>\n The Gleason score is a critical tool for assessing the cancer\u2019s aggressiveness. It ranges from 6 (least aggressive) to 10 (most aggressive), based on how abnormal the cancer cells appear and how they\u2019re arranged.<\/p>\n This score helps oncologists determine whether the cancer is likely to grow slowly or spread quickly \u2014 information that directly influences treatment planning.<\/p>\n 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.<\/p>\n \u201cAbout five to seven percent of prostate cancer patients present with metastatic disease,\u201d Dr. Maithel notes. \u201cMetastatic disease means that the cancer has left the prostate gland itself and has spread to other areas \u2014 specifically, the prostate cancer likes to go to lymph nodes, bones, or the lungs.\u201d<\/p>\n For most men, hormonal therapy (androgen deprivation therapy) is the starting point.<\/p>\n As noted earlier, 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.<\/p>\n In some cases, additional treatments are added to control the disease.<\/p>\n Hormone levels may be lowered through:<\/p>\n ADT often works well for years, but cancer can eventually adapt, leading to castration-resistant prostate cancer (CRPC). When that happens, additional treatments are used.<\/p>\n Drugs like abiraterone, enzalutamide, apalutamide, and darolutamide can further block androgen production or signaling, even after standard hormone therapy stops working.<\/p>\n \u201cThere are new, advanced hormonal therapies which are often combined with the traditional hormonal therapies,\u201d\u00a0Dr. Daniel Hamstra<\/a>, chair of radiation oncology at Baylor College of Medicine, tells SurvivorNet.<\/p>\n \u201cThese are called androgen receptor blockers or ARPIs, and these can provide a more effective treatment, either in the castrate resistant setting or, frankly, in the castrate sensitive setting as well.\u201d<\/p>\n Indeed, 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 a metastatic prostate cancer.<\/p>\n 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. We\u2019ll do a deeper dive into this further down.<\/p>\n If genetic testing of your cancer reveals certain mutations (for example, BRCA1\/2), drugs like PARP inhibitors (olaparib, talazoparib, niraparib, rucaparib) may be effective.<\/p>\n Some men with specific tumor markers (such as mismatch repair deficiency) may benefit from immune checkpoint inhibitors, which help the body\u2019s immune system attack cancer, though Dr. Hamstra notes that the role of immunotherapy in prostate cancer treatment is not yet well-established.<\/p>\n \u201cImmune therapy has not played a huge role in prostate cancer at this point in time, but it is potentially something that may become more relevant,\u201d he explains.<\/p>\n 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.<\/p>\n External beam radiation can be directed at bone metastases or other symptomatic sites to relieve pain or prevent fractures.<\/p>\n Participating in a research study can give access to cutting-edge treatments not yet widely available.<\/p>\n \u201cChemotherapy definitely has a place in the treatment of many men with metastatic prostate cancer,\u201d Dr. Narayan said.<\/p>\n Dr. Narayan emphasizes that \u201cnot all chemotherapy is the same\u201d and the type of chemotherapy used for prostate cancer is often better tolerated than the regimens used for other cancers, such as breast or lung cancer.<\/p>\n WATCH: Chemotherapy in Metastatic Prostate Cancer<\/em><\/strong><\/p>\n \u201cThe chemotherapies that we conventionally use for prostate cancer can actually be better tolerated than some of the chemotherapies people may be familiar with. For example, the treatment of breast cancer, lung cancer, lymphomas, or other diseases that use a lot of chemotherapy,\u201d Dr. Narayan said.<\/p>\n Since chemotherapy in prostate cancer tends to be better tolerated, Dr. Narayan says even older patients can often receive chemotherapy safely and effectively.<\/p>\n \u201cWe certainly have patients with prostate cancer, even in the older ages, seventies and even eighties, who we successfully give chemotherapy to. So, it can be done. There is a trade-off.\u201d<\/p>\n 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.<\/p>\n Dr. Randall Lee<\/a>, a urologic Oncologist at Fox Chase Cancer Center, says the possibility of surgery \u201cdepends on the patient, and it requires a lot of discussion and counseling.\u201d<\/p>\n If the prostate cancer has only spread to a few spots \u2014 or what doctors call oligometastatic disease \u2014 androgen deprivation therapy, along with local radiation therapy, is typically the first choice for control.<\/p>\n WATCH: When Is Surgery Used For Advanced Prostate Cancer? <\/strong><\/em><\/p>\n However, if the patient is dealing with urinary blockage or if the cancer is locally advanced but hasn\u2019t spread to the lymph nodes, Dr. Lee points out that surgery could be an option for some of these patients.<\/p>\n Surgery in advanced prostate cancer isn\u2019t always straightforward. There can be side effects and risks from anesthesia, and it\u2019s important to weigh how the procedure might affect your quality of life while still keeping the cancer in check. That\u2019s why doctors take extra care in deciding who\u2019s a good fit for surgery.<\/p>\n \u201cIn the appropriately selected patient that is counseled on the risks and benefits of surgery\u2026 it is possible, and it\u2019s definitely something that is offered,\u201d Dr. Lee explains.<\/p>\n When it comes to prostate cancer surgery, there\u2019s no one-size-fits-all approach. 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).<\/p>\n This procedure is usually considered for patients whose cancer hasn\u2019t spread beyond the prostate.<\/p>\n It\u2019s important to know that 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.<\/p>\n WATCH: Preparing For Prostate Cancer Surgery: Before, During & After<\/strong><\/em><\/p>\n It can be performed using two primary approaches: open radical prostatectomy or minimally invasive (robot-assisted laparoscopic) prostatectomy.<\/p>\n 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.<\/p>\n Surgery also doesn\u2019t 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) \u2014 that\u2019s when the prostate is enlarged. These surgeries help open up the urinary tract.<\/p>\n \u201cThere 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\u2019t run into issues after radiation or during radiation,\u201d Dr. Lee explained.<\/p>\n If you\u2019re facing advanced prostate cancer, the most important thing is to talk openly with your care team. Don\u2019t hesitate to ask about all your options\u2014including whether surgery makes sense for you. And make sure your personal concerns, like how treatment might affect your urinary symptoms, sex life, or your long-term quality of life, are part of that conversation.<\/p>\n Prostate cancer recurrence is not all that uncommon. A study published<\/a> in the medical journal JAMA followed 1,997 men who had undergone prostate removal surgery. Of those, 304 experienced a recurrence, and about 25% of those cases occurred five or more years after surgery.<\/p>\n Researchers believe that dormant cancer cells can hide in the body for years. The bone marrow, in particular, is considered a key hiding place.<\/p>\n This is supported by findings published<\/a> in the International Journal of Cancer, which noted, \u201cIn one autopsy study, approximately 80% of the men who had died from prostate cancer possessed bone metastases.\u201d<\/p>\n Other potential reservoirs for dormant cancer cells include the lymph nodes and the prostate bed\u2014the area where the prostate gland once was\u2014though these are more difficult to study.<\/p>\n Researchers have made significant strides in understanding how prostate cancer can spread early\u2014even when it appears to be under control\u2014and then return months or even years later.<\/p>\n One key discovery is that the bones are a common site for prostate cancer to spread. In fact, scientists have found dormant cancer cells hiding in the bone marrow of many patients, even when the disease seems confined to the prostate.<\/p>\n Lab studies, mostly using model systems, have also helped uncover how prostate cancer cells can lie dormant for long periods before becoming active again.<\/p>\n While treatments like hormone therapy and radiation after surgery have shown promise, experts agree that more research\u2014both in the lab and in clinical trials\u2014is needed to improve outcomes for patients.<\/p>\n When you do get screened for prostate cancer, your doctor will run a few tests.<\/p>\n 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.<\/p>\n It could also reflect that your prostate is enlarged, which is common, or it could signal an infection or inflammation.<\/p>\n Your doctor may also conduct a digital rectal exam (DRE) to check your prostate for lumps.<\/p>\n Depending on the results of these tests, imaging scans and a biopsy may be ordered.<\/p>\n WATCH: How Gleason Grade Determines Treatment<\/strong><\/em><\/p>\n Prostate cancer does not always behave the same in every man it impacts.<\/p>\n The cancer can be considered \u201clow-risk\u201d 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. Because of this, there is some debate about screening.<\/p>\n The United States Preventive Services Task Force recommends that men at average risk between the ages of 55 and 69 years talk with their doctor about the pros and cons of prostate cancer screening.<\/p>\n The American Cancer Society recommends<\/a> that men at age 50 who are at average risk should begin screening. Men who are at high risk of prostate cancer should begin screening at age 40. Men with a close relative diagnosed with prostate cancer should consider annual screenings in their 30s.<\/p>\n SurvivorNet experts suggested that men consider factors like their family history, genes, and age when deciding whether and when to screen.<\/p>\n Symptoms of prostate cancer may include:<\/p>\n If you have experienced symptoms associated with prostate cancer or have a screening coming up, here are some questions you may ask your doctor:<\/p>\n Learn more about SurvivorNet’s rigorous medical review process.<\/a><\/p>\n\n
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The Benefits of Androgen Deprivation Therapy<\/h2>\n
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Weighing Benefits vs. Long-Term Impacts<\/h3>\n
Expert Resources for Prostate Cancer Patients<\/h3>\n<\/div>\n
Diagnosing Advanced Prostate Cancer<\/h2>\n
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Metastatic Prostate Cancer Treatment<\/h2>\n
Hormone Therapy (Androgen Deprivation Therapy or ADT)<\/h3>\n
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More on Chemo and Metastatic Prostate Cancer<\/h3>\n
When Is Surgery Used For Advanced Prostate Cancer? What Patients Should Know<\/h2>\n
Weighing Risks & Benefits<\/h3>\n
Understanding Prostate Cancer Recurrence<\/h2>\n
Prostate Cancer Screening and Warning Signs<\/h2>\n
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Questions for Your Doctor<\/h3>\n
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