Below is a list of questions to ask your doctor when you’re diagnosed with early-stage disease.
- What is my risk of recurrence after surgery or radiation based on my Gleason score, PSA, rate of PSA rise, and stage?
- What is my risk of progression over time without therapy? Do I need immediate therapy?
- Are you comfortable with me exploring other treatment options and speaking with other specialists (urologists, radiation oncologists, medical oncologists) before deciding upon a final plan of action?
- What are the common side effects of the treatments recommended and when do they occur?
- How many men with prostate cancer do you treat (with surgery, radiation, etc) per year?
- What should I do to keep my body and mind healthy now that I’ve been diagnosed with prostate cancer?
- Based upon what we know today, what is the chance that my cancer spread beyond the prostate? What is the cure rate for this type of cancer?
- Are there additional tests that we can do to gain the most complete understanding of the stage and aggressiveness of my cancer?
- What are all of the treatment options for this stage of cancer?
- What are the benefits of the type of therapy you are recommending?
- What are the drawbacks/side effects of this type of therapy?
- Will I have problems with bladder control or sexual function?
- Will I have other urinary or rectal problems?
- What other treatment(s) might be appropriate and why?
- Is my cancer likely to come back based on what you know today?
- What can I do to improve the success of my therapy?
- What kind of follow-up can I expect after treatment?
- Should I join a clinical trial?
Because the types of treatment for early-stage prostate cancer (surgery and radiation therapy) are so different from each other, it’s important to also discuss the questions specific to the treatment type: what to ask when you’re considering surgery; and what to ask when you’re considering radiation therapy.
When you are considering surgery:
- Which surgical technique will be used? Open, laparoscopic, robotic?
- Based on your experience, why is this the right approach for me?
- Do you plan to employ a nerve-sparing technique with the aim of conserving my ability to get an erection following surgery?
- What level of success have you had in preserving potency (ability to get an erection) in your patients following surgery?
- What about preserving urinary continence (bladder control)?
- What will you do if you find cancer outside of my prostate during the surgery?
- Will that change my prognosis and future treatment?
- Do I need to be concerned about blood loss during the surgery? Should I store my blood or get my family and friends to donate blood in case it is needed?
- What can I expect following the surgery in terms of recovery time? How long will it be before I can return to my normal activities?
- What are the likely or possible side effects of the surgery, both short-term and long-term?
- What will we do to monitor my prostate cancer following the surgery?
When you are considering radiation therapy:
- Which radiation technique will be used? Seeds, external beam, intensity-modulated radiation therapy (IMRT)?
- Based on your experience, why is this the right approach for me?
- How will this procedure precisely target the cancer tissue but leave the normal tissue unharmed?
- Are there specific radiation therapy approaches that we should discuss or consider, such as IMRT or brachytherapy? What about special markers to help guide the radiation dose in real time to possibly prevent toxicity?
- What dose of radiation will you be using and how/why did you select that dose of radiation?
- How often will I need to come into the clinic for treatments?
- Do you recommend that we initiate androgen deprivation therapy (“hormone therapy”) before the radiation treatments? Why or why not?
- What level of success have you had in preserving potency (ability to get an erection) in your patients following this type of radiation therapy?
- What about preserving urinary and bowel continence (bladder and bowel control)? Are there other urinary or bowel side effects that I should be concerned about?
- What can I expect following the treatments in terms of recovery time? How long will it be before I can return to my normal activities?
- Are there delayed side effects that might appear over time?
- What will we do to monitor my prostate cancer following the radiation?
- Are there clinical trials involving radiation therapy that are reasonable for me to consider?
When you are considering active surveillance or deferred therapy for your early stage prostate cancer:
- Why is active surveillance a good option for me?
- What treatment options are there if my cancer progresses?
- How will I be followed? What will be the frequency of PSA tests, rectal examinations, and repeat biopsies?
- When will a repeat biopsy be considered and how will the biopsy information be used to decide on surgery or radiation?
- Who will be the doctor to follow me during this time?
- Are there dietary or lifestyle changes that I can make that can slow prostate cancer growth or that may allow my body to be more healthy to fight this prostate cancer?
- Are there any clinical trials available that may slow the growth of my cancer during this time?
Terms to know from this article:
Gleason Score (GS) - Gleason Grade: A system of grading prostate cancer cells based on how they look under a microscope. Gleason scores range from 2 to 10 and indicate how likely it is that a tumor will spread. A low Gleason score means the cancer cells are similar to normal prostate cells and are less likely to spread; a high Gleason score means the cancer cells are very different from normal and are more likely to spread.
Increase in the size of a tumor or spread of cancer in the body.
The likely outcome or course of a disease; the chance of recovery or recurrence.
A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called internal radiation, implant radiation, or interstitial radiation therapy.
A type of hormone that promotes the development and maintenance of male sex characteristics.
A chemical made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in a laboratory.
Active surveillance is an option offered to patients with very low-risk prostate cancer (low grade, low stage, localized disease). Patients are monitored carefully over time for signs of disease progression. A PSA blood test and digital rectal exam (DRE) and prostate biopsy are performed at physician-specified intervals. Signs of disease progression will trigger immediate active treatment.
The removal of cells or tissues for examination under a microscope. When only a sample of tissue is removed, the procedure is called an incisional biopsy or core biopsy. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy or fine-needle aspiration.
prostate-specific antigen (PSA): A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate.