Metastatic Prostate Cancer: 9 Questions to Ask Your Doctor
CancerProstate Cancer

Questions to Ask Your Doctor About Metastatic Prostate Cancer

Questions to Ask Your Doctor About Metastatic Prostate Cancer
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Updated on September 3, 2026
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A diagnosis of prostate cancer can stir up fear and worry. That’s especially true when it’s metastatic prostate cancer, also known as stage 4 prostate cancer, that has spread from the prostate to other parts of the body.

“The diagnosis of metastatic prostate cancer, or any cancer for that matter, is emotionally debilitating,” says Eleni Efstathiou, MD, PhD, a professor of medicine and chief of genitourinary medical oncology at Houston Methodist Neal Cancer Center in Texas. “We consider cancer to be the worst that can happen to us, and a lot of it has to do with stereotypes of older times where we didn’t have [effective] treatments.”

Today, oncologists have many treatments to slow stage 4 prostate cancer. The more you learn about metastatic prostate cancer and how to manage it, the less frightening it may seem. Asking your doctor some key questions can help you feel more informed.

Where Has My Cancer Spread?

This is one of the first questions to ask an oncologist about metastatic prostate cancer.

Stage 4 prostate cancer manifests in different ways, says Dr. Efstathiou. It can range from cancer that has spread to only one or two places, like distant lymph nodes, to tumors that have reached several organs, like the bones, lungs, and liver.

Your doctor will have you undergo imaging scans, such as a CT scan, MRI scan, bone scan, or PET scan. This will allow them to see exactly where in your body the cancer has spread. They may also do a lymph node biopsy to check if cancer cells are present.

Knowing where the cancer has spread will help your doctor determine the best treatment for you.

How Aggressive Is My Cancer?

The answer to this question will influence which treatment you receive. The most common way to get that answer is to figure out your Gleason score.

This grading system determines how aggressive your cancer is based on how cancer cells removed during a prostate biopsy look under a microscope.

A higher score means your cancer cells look more atypical and indicates a more aggressive cancer, whereas a low score suggests that the tumor is less aggressive. In general, a score of 8 (out of 10) or higher is considered aggressive.

Efstathiou says that prostate cancer that is first diagnosed at an advanced stage usually tends to be more aggressive than prostate cancer that comes back after treatment.

Should I Get a Second Opinion?

If you’ve just been diagnosed with metastatic prostate cancer, you have the option to get a second opinion. In fact, it’s encouraged, especially if you feel unsure.

Each oncologist has their own treatment methods and style. Seeing multiple doctors may give you a better perspective on your options.

Most insurance companies will cover the cost of a second opinion in the case of surgery or other major medical procedures.

 Still, it’s a good idea to check with your insurance company before you make the appointment.

What Are My Treatment Options?

Options for treating metastatic prostate cancer may include:

  • Radiation therapy
  • Hormone therapy
  • Chemotherapy
  • Targeted drug therapy
  • Immunotherapy
  • Surgery

Typically, the first treatment is hormone therapy with a combination of two drugs: one that blocks your body’s production of testosterone (a hormone that helps prostate cancer grow) and another that stops testosterone from getting into the cancer cells to fuel their growth, says Efstathiou.

Which treatment or combination of treatments you get will depend on the cancer’s location and staging.

For example, if your prostate cancer has spread to the bones, your doctor may consider radiation treatments that directly target bone problems or radiopharmaceuticals, which are drugs that contain radioactive elements and can reach all bones at the same time, rather than targeting a specific area.

If your cancer cells have a BRCA1 or BRCA2 gene mutation, you might get a targeted drug called a PARP inhibitor. This medication makes it harder for the cancer cells to repair their own DNA, which speeds up their death.

If your doctor doesn’t suggest genetic testing, ask for it, Efstathiou suggests. Genetic testing can give your doctor more insight into the specific prostate cancer you have and can inform treatment decisions.

Your overall health is another consideration. If you have another serious medical condition like heart disease or diabetes, your doctor might recommend a treatment different than one given to someone without those conditions.

What Side Effects Might I Experience From Treatment?

Each treatment comes with its own potential side effects.

Radiation may cause urinary symptoms and bowel changes during treatment, as well as fatigue and effects on sexual function.

The drop in testosterone levels from hormone therapy can cause other side effects, such as:

Be sure to ask your doctor about the side effects associated with the specific treatments you will be given.

How Can I Manage Side Effects?

Not everyone who gets hormone therapy has side effects, says Efstathiou.

If you do, your doctor can offer additional treatment or lifestyle recommendations to help you manage them. For example, antidepressants may help with depression and hot flashes. Exercise can improve fatigue and reverse weight gain. Medications such as sildenafil (Viagra) and tadalafil (Cialis) are effective for ED.

Prostate cancer treatment and side effects may also affect your mental health, including your self-esteem. It’s best to have open conversations with your healthcare team about what to expect, search out support groups with people who understand your experience, and turn to therapy when needed.

Do You Recommend a Clinical Trial?

None of the prostate cancer treatments that are prolonging lives today would have been possible without clinical trials, says Efstathiou.

These studies can give you access to new — and potentially more effective — ways to treat and manage metastatic prostate cancer.

Ask your doctor whether you qualify for any trials of new therapies for metastatic prostate cancer. Before you enroll, make sure you understand what the therapy is expected to do and what side effects it might cause.

What Lifestyle Changes Should I Make?

Treating prostate cancer involves more than just medication. Lifestyle changes are important, too.

For instance, if you have bone metastasis, your doctor may advise against activities that can predispose you to fractures.

 Eating more fruits and vegetables and fewer saturated fats, exercising often, and losing weight if you’re overweight are all good strategies for staying healthy during your treatment.

Don’t forget to manage your stress, too.

“A lot of men come in already being type A personalities — stressful people with stressful lives. And then on top of it is the stress of [living with] cancer,” Efstathiou says.

Staying active, practicing relaxation techniques like meditation and deep breathing, and seeing a mental health care professional if you feel overwhelmed are all good stress-relief strategies.

What’s My Outlook?

This question is on the minds of many of Efstathiou’s patients, she says.

But your doctor can’t tell you exactly how long you’re going to survive with prostate cancer. That depends on a lot of factors, including the aggressiveness of your cancer, where it has spread, your health, your adherence to treatment, and how well the cancer responds to treatment.

You do have reason to be optimistic, though. Metastatic prostate cancer is among the most treatable cancer, with a five-year survival rate approaching 40 percent.

Survival rates for metastatic prostate cancer are constantly improving as treatment methods evolve.

Instead of asking “How long will I live with prostate cancer?” men should ask, “What is going to be my quality of life?” Efstathiou says.

Questions to Ask Your Doctor

  • Where has my cancer spread?
  • How aggressive is my cancer?
  • Should or can I get gene testing?
  • Should I get a second opinion?
  • What are my treatment goals? Is my cancer curable?
  • What are my treatment options? Which do you think is best for me?
  • What side effects can I get with this treatment? Are any of them permanent?
  • Are there ways or medications to manage these side effects? Can you connect me to a palliative care specialist?
  • What lifestyle changes should I make?
  • Are there any clinical trials I might be eligible for?
  • What’s my prognosis? What will be my quality of life?
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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