Navigating treatment
as a care partner
This photo does not represent an actual patient and care partner.
Your support plays a vital role in helping your loved one navigate advanced prostate cancer treatment
You’re often managing day-to-day challenges, whether it's understanding treatment side effects, coordinating appointments, or simply offering emotional reassurance. Even doing so much, it's normal to feel that you are not doing enough to help your loved one. Feel confident that you are doing the best you can, with the information and skills you have, at the time you have it. This, along with love and kindness, IS enough.
When you help your loved one navigate treatment, it's important to know what to expect, ask the right questions, and feel confident in your loved one's treatment chosen by their care team. This journey is about partnership, and the more informed and supported you feel, the better you’ll be able to care for your loved one—and yourself.
Understanding the available treatment options can help you and your loved one make more informed decisions
The type of treatments that may be offered to your loved one will depend on whether he has localized disease or advanced prostate cancer. Each journey is unique and what works for one person may not work for another, so it’s important to be aware of all the treatment options you have.
It’s important to give your loved one as much autonomy in the decision-making process as possible, since a cancer diagnosis can make them feel robbed of their independence. However, care partners need a voice and should feel empowered to give feedback and insight to arrive at a care plan that works for everyone.
“Once we understood the treatment options, we felt empowered to choose what was best for us, not just what was expected.”
—Susan*, care partner
*Name changed for care partner privacy.
The chart below shows common treatments your loved one may receive during his prostate cancer journey, from localized to advanced disease.1-3
Remember, castration sensitive means the cancer is responding to hormone therapy, while castration resistant means the tumor is starting to grow (PSA rising) while on hormone therapy
Doctor Discussion Guide
Be prepared for treatment conversations. This guide offers key questions to ask about localized or advanced prostate cancer treatment options.
Treatments for localized vs advanced disease
There are many different treatments for prostate cancer, and it’s important to familiarize yourself with when each one can be used. Some treatments are only appropriate for localized disease while others are used only in advanced disease. If their cancer has progressed, the treatment approach will depend on the previous treatments they were on and how well they worked. You also want to make sure you consider side effects of treatment before choosing an approach, as these may significantly impact both you and your loved one’s current and future quality of life.
Treatments for localized prostate cancer
If your loved one’s cancer has not yet spread to other parts of the body or locally spread outside of the prostate, there are treatment options you can consider, including surgery, radiation, hormone therapy, or more conservative options such as active surveillance and watchful waiting. Expand the accordion below to learn more about these treatments.
Active surveillance
- What it is: Close monitoring of low-risk cancer with regular physical exams, PSA tests, imaging and/or biopsies
- Caregiving load: Very light
Active surveillance includes closely monitoring the cancer with regular physical exams and prostate-specific antigen (PSA) tests, and potentially imaging and biopsies if needed. This may be an appropriate option for men with low-risk cancer who do not need immediate treatment, which can help avoid or delay treatment side effects. Consider whether your loved one is comfortable with ongoing monitoring and no implementation of treatment, and whether both of you are prepared for the uncertainty and emotional weight of different testing and waiting1,4
Active surveillance involves a very light caregiving lift for most care partners. At this stage, you may need to take care of transportation to and from doctor's appointments. Encourage your loved one to optimize their health and wellness to prepare for possible treatment in the future
Watchful waiting
- What it is: Less intense monitoring of low-risk cancer when immediate treatment is unnecessary
- Caregiving load: Very light
Watchful waiting is less intensive than active surveillance and may be more appropriate for older men with low-risk cancer or those with other serious health issues. Treatment is usually started only if symptoms appear. This may be a better fit when life expectancy or overall health makes immediate treatment unnecessary—but be aware that this approach may offer less structure or follow-up. You may need to be more diligent about keeping up with follow-up appointments if anything changes
with your loved one1,4
Watchful waiting involves a very light caregiving lift for most care partners. At this stage, you may need to take care of transportation to and from prostate doctor's appointments. Encourage your loved one to start or keep maintaining healthy habits to prepare for possible treatment in the future
Surgery to remove the prostate gland (radical prostatectomy)
- What it is: Surgical removal of the prostate gland and potentially some of the surrounding tissue to eliminate all of the cancer
- Caregiving load: Light
Surgery to remove the prostate gland (called a radical prostatectomy) aims to eliminate all of the cancer by extracting the gland itself. Side effects can include urinary incontinence and erectile dysfunction. Consider long-term treatment impacts such as whether or not your loved one is looking to start a family, as removing the prostate makes the person infertile. Discuss these options with your loved one and his doctor. It is good to seek a second opinion before deciding on surgery, as it may not be needed for low-risk prostate cancer1,4
Prostatectomy is a procedure that is a light caring burden for care partners. Post-prostatectomy, patients may need help with things like catheter maintenance and meals. Care partners can prepare for urinary incontinence (which usually goes away) by purchasing pads or diapers and an extra set of bed sheets to reduce laundry. Surgical incisions are usually small and heal well without the need for significant maintenance
Radiation therapy
- What it is: Procedure to kill cancer cells using high-energy rays
- Caregiving load: Light to medium requiring frequent transportation
Radiation therapy uses high-energy rays to kill cancer cells and can be done from outside the body or through radioactive seeds placed in the prostate. This is one of the most common treatments for localized prostate cancer. Side effects may include changes in bladder and bowel function and sexual side effects. Patients may experience burning with urination, discomfort with bowel movements, or occasionally blood in the urine. These symptoms need to be assessed by their physician and are outside of a care partner's scope of assistance. Before starting radiation, consider logistics like treatment schedule and time commitment, travel coordination, access to specialized centers, as well as long-term side effects, which could include secondary cancers1,4
This type of treatment usually allows for a lighter caring lift for care partners at home, with the exception of transportation, which can be burdensome. Patients will typically need transportation 5 days a week for 4-6 weeks. Care partners will also need to organize logistics for daily appointments, which last about 4-6 weeks. Appointments are usually fast and efficient, about 15-20 minutes, and can be attended by the patient alone, with the exception of the simulation day, which may take 1-2 hours
Androgen deprivation therapy (ADT)
- What it is: Foundational treatment for prostate cancer that works by lowering levels of testosterone to inhibit cancer cell growth
- Caregiving load: Medium to heavy
ADT is the foundation of treatment for prostate cancer and can be used during every stage of the disease. It is more typically used for intermediate or high-risk localized prostate cancer. ADT works to lower the levels of male hormones (androgens) that help the cancer grow and is often used along with other treatments. Common side effects include hot flashes, fatigue, weight gain, loss of bone and muscle strength, and changes in mood or sexual function. For hot flashes, it's helpful to have extra pajamas, towels, and bedsheets handy for quick bed changes at night and to reduce laundry loads. It's important to encourage healthy lifestyle changes such as eating whole foods and exercising to help stabilize mood and regulate sleep. Resistance training can also help your loved one maintain his muscle mass and strength during hormone therapy1,4
ADT can also cause changes in how the body handles sugar, which may lead to insulin resistance and diabetes and can increase risks to heart and blood vessel health. Before starting ADT, talk to the care team about managing side effects that can impact energy, emotional health, and intimacy—especially if you're in a caregiving role. You’ll want to ensure your loved one has a comprehensive care team if he is being treated with ADT5
Discussing treatments at doctor's visits can be overwhelming. With permission, record them on your phone or another device to review later and avoid missing details
Treatments for advanced prostate cancer
If your loved one’s cancer has spread to other parts of the body (called metastatic disease), it’s critical to know what treatments are available to them. Some treatments may also only be approved for certain patient types. Expand the accordions below for detailed information on each treatment.
Androgen deprivation therapy (ADT)
- What it is: Foundational treatment for advanced prostate cancer that works by lowering levels of testosterone to inhibit cancer cell growth
- Caregiving load: Medium to heavy
This may be used for treatment of localized prostate cancer but also plays a significant role in treatment of advanced disease. ADT works to lower the levels of male hormones (androgens like testosterone) that help the cancer grow and is often used with other treatments.1,4
Common side effects include hot flashes, fatigue or tiredness, weight gain, loss of bone and muscle strength, and changes in mood or sexual function. ADT can also change how the body handles sugar, which may lead to insulin resistance and diabetes and can increase risks to heart and blood vessel health.1,5
Understanding your ADT treatment options: GnRH agonists vs antagonists
ADT therapies involve gonadotropin-releasing hormone (GnRH), a hormone naturally produced by the body. There are two types of ADT therapies, called GnRH agonists and GnRH antagonists. Both types work to lower testosterone in men by interacting with GnRH receptors and luteinizing hormone (LH), a hormone that triggers testosterone production and supports reproductive function.6
ELIGARD® (leuprolide acetate) is a proven GnRH agonist that delivers long-term control, customizable dosing, and unmatched access support.7
Learn more about ELIGARD® at Eligard.com.
ELIGARD for injectable suspension is a gonadotropin releasing hormone (GnRH) agonist indicated for the treatment of advanced prostate cancer.
ELIGARD may impair fertility in males of reproductive potential.
See Important Safety Information for ELIGARD at the bottom of this page and full Prescribing Information at Eligard.com.
The accompanying table explains the differences between agonists, like ELIGARD, and antagonists so you can consider which might work best for you and your loved one.6, 8-13
| What It Means | Agonists | Antagonists |
|---|---|---|
| How it works | Slowly lowers testosterone by making GnRH receptors less sensitive and first causing a short rise, then a steady drop. It usually takes 2 to 4 weeks to take full effect. | Lowers testosterone quickly by blocking receptors and the hormone signals. Works within 2 to 3 days. |
| How it’s given | By injection under the skin or into the muscle. | Given as a daily pill or injected once a month. |
| How often | Can be given from monthly to every 6 months, depending on the product. | Taken by mouth every day or injected once a month. |
| Flexibility | More options in how often you receive treatment. | Fewer options for timing and dosing. |
| Other medications | No known interactions when taken with other medicines. | May interact with other medications—be sure to talk to the healthcare team. |
| Types | Leuprolide, goserelin, triptorelin, histrelin. | Degarelix, relugolix. |
| What It Means | How it works |
|---|---|
| Agonists | Slowly lowers testosterone by making GnRH receptors less sensitive and first causing a short rise, then a steady drop. It usually takes 2 to 4 weeks to take full effect. |
| Antagonists | Lowers testosterone quickly by blocking receptors and the hormone signals. Works within 2 to 3 days. |
| What It Means | How it’s given |
|---|---|
| Agonists | By injection under the skin or into the muscle. |
| Antagonists | Given as a daily pill or injected once a month. |
| What It Means | How often |
|---|---|
| Agonists | Can be given from monthly to every 6 months, depending on the product. |
| Antagonists | Taken by mouth every day or injected once a month. |
| What It Means | Flexibility |
|---|---|
| Agonists | More options in how often you receive treatment. |
| Antagonists | Fewer options for timing and dosing. |
| What It Means | Other medications |
|---|---|
| Agonists | No known interactions when taken with other medicines. |
| Antagonists | May interact with other medications—be sure to talk to the healthcare team. |
| What It Means | Types |
|---|---|
| Agonists | Leuprolide, goserelin, triptorelin, histrelin. |
| Antagonists | Degarelix, relugolix. |
When selecting an ADT, consider how often treatment is, other medications your loved one is taking, and any immediate needs to lower testosterone. This will affect ADT choice
Androgen receptor pathway inhibitors (ARPIs)
- What it is: Another form of therapy that works by blocking the activity of male hormones and helps to prevent cancer cell growth
- Caregiving load: Medium to heavy
ARPIs work by blocking the activity of male hormones (androgens) either directly or indirectly, and help prevent cancer cells from growing. ARPIs are commonly added as treatment for both metastatic and non-metastatic prostate cancer, meaning that they can be used regardless of whether the cancer has spread to tissues away from the prostate gland. ARPIs can be used either before or after chemotherapy and should be used along with ADT. Common ARPIs include apalutamide, abiraterone, darolutamide, and enzalutamide.1
Common side effects include fatigue or tiredness, nausea, joint pain, high blood pressure, fluid retention, low levels of potassium, upper respiratory tract infection, adrenocortical insufficiency, liver damage, and coronary heart disease.1
Before starting an ARPI, care partners should consider how the medication’s side effects might impact their loved one’s safety and daily functioning. You should also be prepared to monitor for emotional or psychological effects, like mood swings or depression, which are common with hormonal therapies. Some of these medications may cross the blood-brain barrier and affect cognition. Additionally, consider the logistics and cost of long-term treatment, including insurance coverage, transportation to appointments, and medication management.14
Immunotherapy
- What it is: Treatments to help the body's immune system fight cancer
- Caregiving load: Heavy
Immunotherapy helps the body’s immune system fight cancer and can be used for those with metastatic castration-resistant prostate cancer. Your loved one may be treated with sipuleucel-T or pembrolizumab.1
Common side effects include fatigue or tiredness, nausea and vomiting, joint pain, loss of appetite, infusion-related reactions or injection site pain, chills, and muscle weakness.15
Other considerations for care partners include coordinating complex treatment logistics with immunotherapies, which may require travel to specialized centers for things like infusions and cell collection. You should also be prepared to manage side effects, assist with transportation, and provide ongoing emotional and scheduling support throughout the treatment process.
Poly (ADP-ribose) polymerase inhibitors (PARPis)
- What it is: Anti-cancer agents that reduce the growth and spread of cancer cells by preventing DNA repair
- Caregiving load: Medium
PARPis work to stop the PARP protein from repairing DNA in cells, including cancer cells. When damaged DNA cannot be repaired, the cell dies, helping reduce the growth and spread of cancer cells. These treatments are especially effective for patients with metastatic castration-resistant prostate cancer who have BRCA gene mutations. PARPi therapies include rucaparib, olaparib, niraparib, and talazoparib.16-22
RUBRACA® (rucaparib) is indicated for the treatment of adult patients with a deleterious BRCA mutation (germline and/or somatic)-associated metastatic castration-resistant prostate cancer (mCRPC) who have been treated with androgen receptor-directed therapy.18
Learn more about RUBRACA at RubracaProstate.com.
RUBRACA is indicated for patients previously treated with any androgen receptor-directed therapy.
Myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) occur in patients treated with RUBRACA, and are potentially fatal adverse reactions.
For Important Safety Information and full Prescribing Information for RUBRACA, visit RubracaProstate.com.
Common side effects include anemia, low levels of red or white blood cells or platelets, and low levels of neutrophils. More serious side effects like secondary cancers can develop as well, such as myelodysplastic syndrome and acute myeloid leukemia, which could warrant discontinuing treatment.18
Before a loved one begins a PARPi, understand that eligibility for use must be confirmed through genetic testing. It’s important to be aware of common side effects, including fatigue, nausea, anemia, and increased risk of infection, which may require ongoing lab work and careful symptom monitoring. There will also be a need for frequent medical follow-ups, such as monitoring blood counts and making dose adjustments if needed, which can add to the practical and emotional burden of care. The financial cost of PARPi therapy can be a concern, so exploring insurance coverage and assistance programs in advance is important.
Chemotherapy
- What it is: Anti-cancer agent that slows down or kills cancer cells by interfering with cell division
- Caregiving load: Heavy
Chemotherapy might be used in your loved one’s treatment plan to help slow down or kill cancer cells. Docetaxel is a common option for metastatic prostate cancer, while cabazitaxel may be used if docetaxel is no longer effective.15
Common side effects include fatigue or tiredness, nausea and vomiting, joint pain, loss of appetite, infusion-related reactions or injection site pain, chills, and muscle weakness.15
Chemotherapy can be a difficult treatment to manage since it can cause numerous debilitating side effects. The majority of side effects occur during days 1-10 (day 1 is the first day of infusion, with day 10 usually being the day blood counts are at their lowest and slowly begin to recover). Care partners can help by making sure the patient has essentials for the day of the infusion such as bottled water, a small blanket, a book, a phone charger, and snacks. They can also provide transportation to and from the infusion center if they are not able to stay during treatment. Following the chemotherapy infusion, care partners can give gentle reminders about taking anti-nausea and pain medication when needed, and encourage the patient to stay hydrated and eat small, light meals throughout the day.
Depending on where the patient is in their treatment journey, chemotherapy can be a moderate to heavy caregiving load for the care partner. Specific items care partners can prepare for are:
- Light meals (small meals throughout the day)
- Medication management
- Transportation
Care partners, especially those who live with the patient, are on duty 24/7. This means they rarely get any mental or physical time off. Any amount of time away from the house and away from the patient allows them an opportunity to relax and disengage which is essential for their well-being. Identifying ways to get respite during chemotherapy treatments is an excellent way care partners can try to prepare for this part of the journey.
Radioligand therapy (RLT)
- What it is: Anti-cancer therapy that uses targeted radiation to kill or slow down cancer cell growth
- Additional consideration: Limit close contact for a few days due to levels of radiation
- Caregiving load: Heavy
RLT works to deliver radiation directly to cancer cells to help slow their growth. If cancer has spread to the bones, radium-223 can be used to specifically target the cancer and help relieve symptoms. Lutetium-177 is another option that works by targeting prostate cancer cells in the body, since it is attached to a protein that specifically binds to the surface of prostate gland cells.15
Common side effects include urinary problems, kidney toxicity, fatigue or tiredness, nausea and vomiting, dry mouth, and bone marrow suppression.15
When your loved one is undergoing RLT, you may need to consider logistics such as transportation for frequent lab or clinic visits. They may also need a separate bathroom and bedroom for several days after receiving this treatment. Consider planning for this ahead of time.
Other considerations for care partners include limiting close contact—especially with children and pregnant individuals—for a few days after RLT due to levels of radiation. You may need to communicate these boundaries to family/
friends as needed. Your loved one will also need to stay well-hydrated to flush the treatment from their system and avoid strenuous activity for about a week.15
When your loved one uses the bathroom, they will need to flush twice (clean flushes) and may need gentle hygiene reminders. They may experience changes in taste and their diet may need to shift depending on the severity of this change.
Although this is a relatively light caregiving lift from a treatment standpoint, patients receiving radioligand treatment have metastatic disease involving the bone or bone and soft tissue organs, which means they may require a higher level of care at home. If possible, use this time to optimize your own health and wellness as much as possible with exercise and a healthy diet.
Always discuss side effects and concerns with the healthcare team before starting treatment and seek second opinions if needed. Ask about clinical trials, as new options are continually explored
Remember to be there for your loved one
Watching a loved one deal with cancer takes a significant toll on you as a care partner.
One of the most valuable things you can do when you see your loved one struggling is to acknowledge what they are experiencing (such as depressed mood, anxiety, or irritability) and ask if there is anything you can do to help. If they are not open to help or are not in a space to discuss their feelings, exhibit healthy behavior by taking care of yourself directly. This may look like sitting in a quiet space, taking a short walk, placing a phone call to a friend, or exercise if time permits.
You should also understand that it’s not your job to appease family members or to make sure everyone agrees with the patient’s chosen course of action for treatment. Putting this boundary in place may be difficult to do, but maintaining focus on your loved one's goals makes this a bit easier.