Sample report — metastatic hormone-sensitive prostate cancer

This report is educational only. It is not a diagnosis, a treatment plan, or a second opinion, and it is not a replacement for your cancer care team. Do not start, stop, or change any medicine, supplement, or treatment based on this report. Talk with your urologist, oncologist, or primary care clinician before you act on anything here.

If you have any of the following, stop reading and get emergency care now: sudden new weakness or numbness in your legs, loss of bowel or bladder control, inability to urinate at all, uncontrolled bleeding, severe chest pain, or trouble breathing. In the United States, call 911.

This is a sample report shown for illustration. The person, PSA values, and details below are fictional.

You have prostate cancer that has spread to bones (bones in the spine and ribs). Because you have not yet been treated for cancer at the hormone-sensitive stage — apart from just starting ADT — your disease is called metastatic hormone-sensitive prostate cancer (mHSPC). Your PSA fell from 112 to 4.2 after starting ADT, which shows the cancer is responding. Your care team has raised adding a second drug and possibly chemotherapy. You want to understand the combinations and their trade-offs.

Multiple large randomized trials have shown that adding a second agent to ADT for men with mHSPC lengthens life compared with ADT alone. This is now standard of care for most patients who can tolerate combination therapy. The main choices to add to ADT are: an androgen receptor pathway inhibitor (abiraterone, apalutamide, enzalutamide, or darolutamide), or docetaxel chemotherapy, or in selected higher-burden cases the 'triplet' of ADT + darolutamide + docetaxel.

• ADT + abiraterone + prednisone: oral pill, daily; monitored for liver enzymes, potassium, and blood pressure.
• ADT + enzalutamide: oral pill, daily; monitored for fatigue, fall risk, and rarely seizures.
• ADT + apalutamide: oral pill, daily; monitored for rash, thyroid, and fall risk.
• ADT + darolutamide: oral pill, twice daily; typically fewer central-nervous-system side effects than other agents in its class.
• ADT + docetaxel chemotherapy: usually six cycles, given IV every three weeks; risks include neutropenia, fatigue, neuropathy, hair loss.
• Triplet therapy (ADT + darolutamide + docetaxel) for higher-volume disease: combines the benefits and side-effect risks of both approaches.

You have bone metastases and you will be on long-term ADT — both of these accelerate bone loss and raise fracture risk. Ask your team about: - A baseline bone density (DEXA) scan. - A bone-protective agent (denosumab or zoledronic acid) at the dose used for bone metastases, not just the osteoporosis dose, if you have symptomatic bony disease. - Calcium and vitamin D intake. - A dental evaluation before starting denosumab or zoledronic acid, because of the risk of osteonecrosis of the jaw.

Common effects: hot flashes, fatigue, loss of libido and erectile function, mood changes, weight gain and muscle loss, hot flashes, night sweats, and slow gradual bone density loss. Metabolic effects (higher blood sugar, higher cholesterol) are common and worth monitoring. Regular resistance exercise, aerobic activity, and attention to cardiovascular risk factors have documented benefit in men on ADT.

You named 'avoid chronic pain' as a priority. Palliative care teams are specialists in symptom control and quality of life and can be involved from the day of diagnosis alongside your oncology team. Palliative care is not the same as hospice and does not mean stopping cancer treatment. Early palliative care involvement in advanced cancer has been shown to improve both symptoms and, in some studies, survival.

• Do I have 'high-volume' or 'low-volume' metastatic disease by the CHAARTED definition, and does that change what you recommend?
• Which combination do you recommend for me, and why that one over the alternatives?
• Am I a candidate for triplet therapy?
• What bone-protective medicine will I be on, and when do I need a dental clearance?
• Can we involve palliative care now for symptom support?
• What symptoms should make me call you or go to the emergency room right away?

Clinical trials in mHSPC are active and evolving quickly, including trials of PSMA-targeted therapy, novel combinations, and biomarker-selected treatment. You can search at prostatecancertrials.org and bring anything relevant to your oncologist.

We do not have your imaging report (bone scan and CT or PSMA PET), the volume and location of metastases beyond what you described, your germline genetic testing (BRCA1/2, ATM, MMR), any tumor genomic testing, and your current blood work (kidney, liver, blood counts). Each of these can materially change which combination is recommended.

You are welcome to create another report when you have more information to include, such as imaging results, genetic testing, current lab values, or specific treatment recommendations you have received. You can include that new information along with any additional questions you have, and we will produce an updated report.