Appointment sheet
Localised prostate cancer, very low and low risk
Prepared with OnCo (onco.cc/prep/prostate-low-risk/). 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
16 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 PSA and PSA density, Gleason Grade Group 1 on biopsy, MRI PI-RADS score, Genomic classifier, Germline BRCA2 testing when family history warrants), 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?
Very low and low risk, preferred
- 5.For my situation (very low and low risk, preferred), which of the standard options do you recommend and why?
- 6.How do the results of ProtecT apply to someone like me?
Low risk, men who prefer treatment
- 7.For my situation (low risk, men who prefer treatment), which of the standard options do you recommend and why?
- 8.How do the results of CHHiP and PACE-B apply to someone like me?
Diagnosis
- 9.For my situation (diagnosis), which of the standard options do you recommend and why?
- 10.Am I a candidate for Decipher Prostate, ArteraAI Prostate, and what side effects should I expect?
- 11.How do the results of PRECISION apply to someone like me?
Any stage
- 12.Are there clinical trials I could join, for example of ArteraAI Prostate, Decipher Prostate, Multiparametric prostate MRI (PI-RADS)?
- 13.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 14.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 15.I read that “Which Grade Group 1 cancers will upgrade, and whether Grade Group 1 should be called cancer at all”. How does that affect my plan?
- 16.I read that “How often to repeat biopsy on surveillance and whether MRI alone can replace it”. How does that affect my plan?
The words I may hear
- Overtreatment: Treating a cancer that was never going to cause trouble.
- Lead time, and lead-time bias: Finding a cancer earlier means you know about it for longer, even if nothing you do changes the day you die.
- Percentage of Gleason pattern 4: How much of the cancer in a biopsy is the more aggressive pattern 4 rather than the slower pattern 3.
- Focal and tissue-preserving treatment of prostate cancer: Treating only the part of the prostate that contains the cancer, with heat, cold or light, preserves erections and continence better than removing or irradiating the whole gland.
- PSA density: The PSA divided by the volume of the prostate measured on the scan.
- Gleason score / Grade Group: The pathologist's 1-to-5 grade of how abnormal prostate cancer looks, which drives most treatment decisions.
- 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.
- 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.
Tests and results to bring
Diagnosis: MRI before biopsy and targeted plus systematic cores; genomic classifiers or AI pathology to refine surveillance decisions.
Biomarker results to ask for: PSA and PSA density, Gleason Grade Group 1 on biopsy, MRI PI-RADS score, Genomic classifier (Decipher, Oncotype DX GPS, Prolaris), Germline BRCA2 testing when family history warrants.
Scans and tests linked to this cancer: Active surveillance, Multiparametric prostate MRI (PI-RADS), Digital pathology & AI, RNA sequencing & expression profiling.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Very low and low risk, preferred: Active surveillance with PSA every six months, MRI and repeat biopsy; treatment only on progression to Grade Group 2 or more. (Active surveillance, ProtecT, Multiparametric prostate MRI (PI-RADS), PSA (prostate-specific antigen), Gleason score / Grade Group)
- Low risk, men who prefer treatment: Radical prostatectomy, moderately hypofractionated external beam radiotherapy, five-fraction stereotactic radiotherapy or brachytherapy, without hormone therapy. (Robotic & minimally invasive surgery, Hypofractionated radiotherapy, SBRT / SABR (stereotactic radiotherapy), Brachytherapy, CHHiP, PACE-B)
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