Why Healthy Lifestyles Can Still Lead to Metastatic Prostate Cancer

Randy, a retired Macy's executive living in Phoenix, considered himself healthy before his cancer diagnosis. He exercised, watched what he ate and credits his mother, who kept sugar, salt and snacks out of the house, for those habits.

When back pain and muscle spasms did not improve after months of chiropractic care and massage, Randy asked his primary care doctor to check his prostate-specific antigen (PSA) level. The result led to a diagnosis of metastatic castration-sensitive prostate cancer (mCSPC), meaning cancer that has spread to other parts of the body but still responds to hormone therapy.

His medical oncologist, Dr. Wishwdeep S. Dhillon of Arizona Center for Cancer Care, treated him with Nubeca (darolutamide), a drug that blocks testosterone from attaching to cancer cells, in combination with androgen deprivation therapy (treatment that lowers testosterone) and Taxotere (docetaxel) chemotherapy.

Nearly two years after ringing the bell in Dhillon's office, Randy spoke with CURE following Prostate Cancer Awareness Month about getting checked, coping with an advanced diagnosis and the people who helped him through it.

CURE: What led a healthy, active man to get tested for prostate cancer?

Randy: It started when I was doing a landscaping project at one of my daughter's homes in California. It was over Thanksgiving, and probably about two hours into it, my back completely tightened up, to the point where I had to lay down, get some ice and take some medication for it. When I got home, the pain was still there. I started to see a chiropractor, and I also started doing massage. But unfortunately, after a few months of that, it did not change, and I felt to myself, being healthy, that there must be something else going on.

Both my chiropractor and Tim [my husband] agreed that I should go see my GP, which I did. He wanted to give me some muscle relaxants, which I said was fine. But I also [said], "I want you to check my PSA." Two days later, he called me and said, "Randy, your PSA is highly elevated. You need to see a urologist right away."

What is it like to hear a metastatic prostate cancer diagnosis?

The very first thing that happened, and I think it happens to a lot of people, is the emotional piece of it. I literally started crying when I heard it, and I grabbed my husband's hand, and he was crying. One of the best parts of Dr. Dhillon is his ability to read emotions, and he stepped back and gave us the time and the space to work through that.

Once we stopped, my response to him was, "I want you to come up with the best possible treatment plan that you think will work for me, and I will do the rest. I will take care of myself physically, emotionally and spiritually." Looking back at it, I think that moment in time really set the stage for our partnership since that day of diagnosis.

How does Randy look back on the time before his prostate cancer diagnosis?

I don't like to live on the what-ifs or the what-I-should-have-dones. There certainly is some history of cancer in my family, between my mom and my older brother, and my oldest daughter got breast cancer, so I probably should have done better due diligence. But I don't regret anything that I did in the way I did it, because I have come to a place where I can say that I've come to peace with my cancer. I don't let it consume me, and therefore I don't dwell on the past and the things that I could have done.

How can patients cope with the emotional side of advanced prostate cancer?

We all have a couple of paths we can choose when we're diagnosed with any kind of trauma, any kind of cancer, because it's a big deal. You could take the path of fear and anxiety as a patient, or, for me, I chose the path of hope and positivity. Though there were difficult emotions that came in as I went through some of those early months of treatment and some of the early side effects, I constantly reminded myself that once we get through this, I am going to return to my new normal. That's what people call it, but I call it my normal life.

I'm very fortunate to have a husband who really understands me. He gets me, and every day he would check with me to see how I was doing. We always talked about hope and positivity, and that was our way of approaching my cancer.

How can family support someone living with advanced prostate cancer?

I think the immediate reaction for them was a lot of fear, but we walked through that via Zoom calls with the girls and their husbands, and we even brought the grandkids into it because we wanted them to understand what was going on. Their support has been absolutely amazing in the very beginning, and even up until the other day, they will constantly check in with me to see how we're doing. They want to know about my results when I go in and get blood work. But most of all, they want to spend time with me.

We have taken several vacations together now, just enjoying each other, and cancer really isn't a big topic of conversation anymore because I choose for it not to be, and they understand that.

What milestones matter after treatment for advanced prostate cancer?

There actually is a milestone that is coming up in another week or two, and that is I rang that bell in Dr. Dhillon's office two years ago. That to me is a big milestone, and I don't take it for granted at all. I take it with a lot of gratitude.

We delayed [a cruise] for medical reasons, and eventually we were able to take that cruise, and we took the kids. I can remember Tim and I walking up that ramp onto the ship. We were taking it out of Long Beach, and we both literally broke down and started crying. Those tears were happy tears because we weren't sure that that day would ever come back, where we'd be able to travel again and do the things that we do with the kids. In the last two years, I'm just going to guess, but I think we've taken probably four or five cruises and several vacations with the kids.

How has advanced prostate cancer changed Randy's outlook on life?

I certainly don't take life for granted. I do have a heightened awareness of potentially lost time, as some people might call it, but I don't dwell on that. I rarely think about cancer other than when I'm doing things like this. I want to make sure that each and every day I live in the present, and do the things that I like to do with my husband Tim and my family. We have a very, very strong village of friends that have always been there, and we spend a lot of time with them now on weekends, or birthday parties, or dinner parties.

It's really a focus on the present, and it's a real focus on not taking my health for granted. I will not do that. I didn't do it in the past, and I certainly won't do it now. For example, this morning I got up at 5 o'clock, knowing we were going to do this, and went to the gym for two hours. Those are the things I do to take care of myself.

What advice does Randy have for men diagnosed with prostate cancer?

For any patient out there at any level of prostate cancer or any cancer, the number one thing is to build a really strong medical team: a team that you can trust, and one that allows you to participate in your treatment options, but also where you feel that you can be very transparent in communicating all things emotional, all things medical. We oftentimes focus on the oncologist, which is appropriate, but when I say medical team, that means the entire team around that oncologist.

The second thing that really applies to men with prostate cancer is they need to be able to surround themselves with people that they can trust, people that they can depend on, people that will show up when they need them. And most importantly, I think they need to find that one special individual that they can truly share the emotions that they go through with, because as men we don't do a very good job of that. But it's an opportunity to really help you navigate the whole process of treatment after diagnosis and then life after treatment.

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