Dr. Ravi Kumar
Urologic Oncologist & Surgeon
For men living with metastatic prostate cancer, treatment can mean more than managing disease — it can mean preserving the life they love.
Tony Maddalena developed severe leg pain in January 2025. In his mid-sixties and active, he attended physical therapy until March despite the occasional inability to walk. He finally went to the hospital and was diagnosed with metastatic prostate cancer that had spread to his spine. Prior, he recalled fatigue and several other issues he’d attributed to age.
Dr. Ravi Kumar, a urologic oncologist and surgeon, says Maddalena represents the group of men who “unfortunately present with metastatic disease from the outset — sometimes due to bone pain, urinary problems, fatigue, weight loss, or an elevated PSA.” PSA, or prostate-specific antigen, is a protein produced in the prostate. Up to 4ng/mL can be normal depending on age; anything higher may require further investigation.
The diagnosis is serious but Dr. Kumar says “the treatment landscape has changed dramatically” with “often much more reason for hope than men initially realize.” He focuses on long-term management centred around patient priorities and emphasizes quality of life.
Adapting care over time
Regular PSA testing, imaging, and clinical follow-up can identify changes early and trigger potential treatment shifts. “Prostate cancer can change biologically over time, and treatments that work extremely well initially may eventually become less effective,” says Dr. Kumar. Men should monitor for new or worsening bone pain, especially in the back, and weakness, numbness, walking difficulty, or bladder and bowel control issues.
Traditional androgen-deprivation therapy lowers testosterone and reduces PSA levels, providing relief for many initial symptoms. It can now be combined with advancements like androgen-receptor-targeted medications, chemotherapy, radiation, and targeted pharmaceuticals. Each patient is assessed regularly to determine what’s best for their lifestyle goals.
Appropriate care evolves alongside patient needs. “Treatment plans aren’t contracts,” advises Dr. Kumar, and good care balances health alongside evolving personal priority.
Care that fits your life
Dr. Kumar’s approach is patient-first. “What is most important to you right now?” he asks, acknowledging no two patients are alike. Whether living independently, working, or taking a trip, “treatment should work with the patient’s life whenever medically safe.”
For Maddalena, that meant remaining active, working, and enjoying family time, especially with his grandchildren, and so far he’s three for three. Regarding initial concerns, he says he met Dr. Kumar and knew he’d be in good hands.
Dr. Kumar also stresses that no topic is off-limits. Sexual intimacy, financial hardship, and changing body image are important care considerations, and the multidisciplinary team provides support for both patients and caregivers. He wants patients to live longer but emphasizes that “the goal is not simply to add time to someone’s life; whenever possible, we want to preserve the quality of life within that time.”
Finding strength through support
Health care specialists provide treatment and patient education through various referrals, including sexual-health counselling, dietitians, peer support and educational programming through Prostate Cancer Support Toronto, and more.
Reflecting, Maddalena wishes he’d known about early signs or testing, but says he feels good and wants to educate men to get checked while offering reassurance that a meaningful life is still possible with new treatments and supportive health care teams.
When asked if he’d like to participate, he thought “absolutely, it’s so important that people understand that a prostate cancer diagnosis doesn’t define you, you can still live well and thrive at home and at work.”
Speak with your health care provider about the care and support available to you, or visit prostatecancer.ca.
This article was made possible with support from Bayer Canada.