The first 60 days: Localised prostate cancer, high and very high risk

What happens now

Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.

Biomarkers your report may list

Gleason Grade Group 4 or 5 PSA above 20 ng/mL PSMA PET staging Germline and tumour HRR testing (BRCA2 in particular)Decipher genomic classifier

Ask which of these were tested and what the results were; see the report reader for what each value means.

Tests and imaging linked to this cancer

Active surveillance PSMA PET Digital pathology & AI RNA sequencing & expression profiling

How it is staged

Localised prostate cancer: the Cambridge Prognostic Groups (NICE)

Weeks 1 to 3

Who is on your team

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These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.

A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.

Weeks 2 to 6

Decisions coming up

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Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.

1.High risk NCCN Guidelines: Prostate Cancer
External beam radiotherapy to prostate and pelvic nodes with 18 to 36 months of androgen deprivation, with or without brachytherapy boost; or radical prostatectomy with extended lymph node dissection.
IMRT / IGRT (modern external beam)Androgen deprivation & AR pathway inhibitors Leuprolide (leuprorelin) and GnRH agonists Degarelix Relugolix Brachytherapy Robotic & minimally invasive surgery HYPO-RT-PC
2.Very high risk and node-positive NCCN Guidelines: Prostate Cancer
Radiotherapy plus androgen deprivation with two years of abiraterone (STAMPEDE); PSMA PET staging before treatment.
Abiraterone acetate STAMPEDE PSMA PET proPSMA
3.After prostatectomy with adverse pathology
Adjuvant or early salvage radiotherapy guided by PSA, with hormone therapy for higher-risk features.
IMRT / IGRT (modern external beam)Androgen deprivation & AR pathway inhibitors PSA (prostate-specific antigen)Biochemical recurrence (BCR)

Every visit

Questions to ask at each visit

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Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.

Newly diagnosed

What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
Which biomarkers have been tested on my tumour (for example Gleason Grade Group 4 or 5, PSA above 20 ng/mL, PSMA PET staging, Germline and tumour HRR testing, Decipher genomic classifier), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include High risk, Very high risk, Locally advanced adenocarcinoma with seminal vesicle invasion.
Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.

High risk

For my situation (high risk), which of the standard options do you recommend and why?Guideline options include: External beam radiotherapy to prostate and pelvic nodes with 18 to 36 months of androgen deprivation, with or without brachytherapy boost; or radical prostatectomy with extended lymph node dissection.
Am I a candidate for Leuprolide (leuprorelin) and GnRH agonists, Degarelix, Relugolix, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of HYPO-RT-PC apply to someone like me?Trial populations differ from individual patients; ask how closely you match.

Very high risk and node-positive

For my situation (very high risk and node-positive), which of the standard options do you recommend and why?Guideline options include: Radiotherapy plus androgen deprivation with two years of abiraterone (STAMPEDE); PSMA PET staging before treatment.
Am I a candidate for Abiraterone acetate, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
How do the results of STAMPEDE and proPSMA apply to someone like me?Trial populations differ from individual patients; ask how closely you match.

After prostatectomy with adverse pathology

For my situation (after prostatectomy with adverse pathology), which of the standard options do you recommend and why?Guideline options include: Adjuvant or early salvage radiotherapy guided by PSA, with hormone therapy for higher-risk features.

Any stage

Are there clinical trials I could join, for example of PSMA PET, ArteraAI Prostate, Decipher Prostate, Abiraterone acetate?Trials are how the next standard of care is set; asking early keeps options open.
Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
I read that “How long hormone therapy should last when abiraterone is added”. How does that affect my plan?Open problems are where trials and second opinions matter most.
I read that “Whether PSMA PET-detected nodes should change treatment when the trials were staged conventionally”. How does that affect my plan?Open problems are where trials and second opinions matter most.

Weeks 3 to 8

Trials to ask about

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Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.

From day one

Help that costs nothing

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Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.

Any time

What to read next

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Words this page and the cancer page use

Biochemical recurrence (BCR): PSA rising again after surgery or radiation, usually years before anything shows on a scan.
Chromoplexy: Instead of collecting damage one mutation at a time, a prostate cancer genome can be scrambled in a single burst: several chromosomes break at once and are stitched back together in a chain, knocking out several cancer genes in one event.
Extraprostatic extension and seminal vesicle invasion: Whether the cancer has grown out through the wall of the prostate (pT3a) or into the seminal vesicles behind it (pT3b).
STAMPEDE's arms, and what each one answered: One British trial, running since 2005, has asked nine separate questions about prostate cancer treatment by adding new arms as the answers came in.
Number needed to screen (and number needed to diagnose): How many men have to be offered the test for one man to be saved from dying of prostate cancer, and how many extra cancers have to be found along the way.
PI-RADS (Prostate Imaging Reporting and Data System): The international scoring system radiologists use to say how likely a prostate MRI finding is to be a serious cancer, from 1 (very unlikely) to 5 (very likely).
Polygenic risk score (PRS): A single number adding up hundreds of common, individually tiny genetic differences to say whether a man's inherited risk of prostate cancer is above or below average.
Intermittent androgen deprivation (IAD): Taking planned breaks from hormone therapy once the PSA has settled, restarting when it rises again.
Template mapping biopsy (transperineal template prostate mapping): A thorough biopsy done under general anaesthetic through the skin behind the scrotum, using a grid to sample the whole prostate systematically.
Whole-mount pathology: Slicing the whole removed prostate into complete cross-sections on oversized slides, so each slide shows the entire gland in one piece rather than in fragments.

Every term links to the glossary.