Being told that you have prostate cancer is often overwhelming. But there is something important to know already now: a prostate cancer diagnosis is not the same thing as an acute threat to your life. What decides the way forward is not the diagnosis in itself – it is how aggressive the cancer is. This article takes you through the five most important steps after a prostate cancer diagnosis.
What does prostate cancer actually mean?
Prostate cancer is not a single disease – it is a spectrum. A man with low-risk prostate cancer lives in many cases for decades without the cancer affecting his health or his life expectancy. Another man with high-risk cancer may need treatment relatively soon. That is why the diagnosis is only step one. Step two – and the important one – is to establish how aggressive the cancer actually is. It is that assessment which determines whether you need surgery, radiotherapy or hormone therapy – or whether you can wait under active surveillance. You can read more about the disease and how it develops on a separate page.
What happens immediately after the diagnosis?
The diagnosis is usually confirmed through a tissue sample, a biopsy, from the prostate gland. The sample is sent to a pathologist who examines the tissue under a microscope and assesses the appearance and aggressiveness of the cancer. The result is presented as a Gleason score or an ISUP grade group (1–5), where a higher number means more aggressive cancer. In addition to the biopsy result, your doctor usually has access to your PSA level, the results of any MRI scan and information about where the tumour is located. All of this is weighed together into a treatment recommendation. Here you can read more about your PSA level PSA levels.
What treatment options are there?
Depending on how aggressive the cancer is judged to be, your doctor may discuss several options: active surveillance (following the cancer without immediate treatment when aggressiveness is low), radical prostatectomy (surgery that removes the whole prostate gland), radiotherapy, hormone therapy, or watchful waiting (a more passive approach, usually with higher age or comorbidity). Which option is right for you is discussed in a multidisciplinary team – a group of specialists in urology, oncology and pathology.
How long does the investigation process take?
From diagnosis to treatment decision often takes a few weeks to one or two months. It can feel like a long time, but for most people it is medically defensible – prostate cancer is generally not a disease that requires immediate intervention. The period is, however, important for making sure that the basis for the decision is as good as possible.
One thing at a time
It rarely helps to jump ahead to scenarios you do not yet have the facts for. What gives real reassurance is making sure that the material you and your doctor base your decision on is as correct and well-founded as possible – including the assessment of aggressiveness in your biopsy.
You may also find answers here:
- How certain is your prostate cancer diagnosis, really? Article 2 – How certain is the diagnosis
- Active surveillance or surgery – how is it decided? Surveillance vs. surgery
- How is a prostate cancer diagnosis made? PSA, MRI and biopsy Making a diagnosis
Do you want to be sure the underlying assessment is right?
An independent assessment of your tissue sample can give a more reassuring basis for the next step.