Appointment sheet
Non-metastatic castration-resistant prostate cancer
Prepared with OnCo (onco.cc/prep/prostate-nmcrpc/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
14 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example Castrate testosterone, PSA doubling time, Conventional imaging negative, PSMA PET, AR alterations and AR-V7), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
High-risk nmCRPC (doubling time 10 months or less)
- 5.For my situation (high-risk nmcrpc (doubling time 10 months or less)), which of the standard options do you recommend and why?
- 6.Am I a candidate for Apalutamide, Enzalutamide, Darolutamide, and what side effects should I expect?
Low-risk nmCRPC
- 7.For my situation (low-risk nmcrpc), which of the standard options do you recommend and why?
- 8.Am I a candidate for Bicalutamide, and what side effects should I expect?
Staging
- 9.For my situation (staging), which of the standard options do you recommend and why?
Any stage
- 10.Are there clinical trials I could join, for example of Darolutamide, PSMA PET, AR-V7 splice variant?
- 11.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 12.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 13.I read that “Whether PSMA PET-detected metastases should be treated locally or the man treated as metastatic”. How does that affect my plan?
- 14.I read that “Cost and side effects of years of androgen receptor inhibition in men without symptoms”. How does that affect my plan?
The words I may hear
- mCRPC and mHSPC (castration-resistant vs hormone-sensitive prostate cancer): Prostate cancer starts out fed by testosterone (hormone-sensitive) and shrinks when it is removed.
- AR-V7 splice variant: A truncated form of the androgen receptor that is permanently switched on and ignores hormone-blocking pills.
- Castration-resistant prostate cancer (CRPC): Prostate cancer that keeps growing even though testosterone has been reduced to castrate levels.
- PSA (prostate-specific antigen): A blood protein made by the prostate; raised levels prompt further tests, and falling levels show treatment is working.
Tests and results to bring
Staging: PSMA PET locates disease in most men; conventional imaging still defines the setting the trials studied.
Biomarker results to ask for: Castrate testosterone (below 50 ng/dL), PSA doubling time, Conventional imaging negative, PSMA PET (often positive), AR alterations and AR-V7 (research).
Scans and tests linked to this cancer: PSMA PET.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- High-risk nmCRPC (doubling time 10 months or less): Continue androgen deprivation and add apalutamide (SPARTAN), enzalutamide (PROSPER) or darolutamide (ARAMIS); darolutamide preferred when falls or cognition are concerns. (Apalutamide, Enzalutamide, Darolutamide, Androgen deprivation & AR pathway inhibitors, Castration-resistant prostate cancer (CRPC))
- Low-risk nmCRPC: Observation on androgen deprivation with PSA monitoring and imaging; first-generation antiandrogen or its withdrawal as older options. (Androgen deprivation & AR pathway inhibitors, Bicalutamide, PSA (prostate-specific antigen))
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call