The first 60 days: Localised prostate cancer, high and very high risk
High-risk prostate cancer has Grade Group 4 or 5 disease, a PSA above 20 or a tumour growing beyond the gland. It is still curable, but needs radiotherapy with two to three years of hormone therapy, or surgery followed by radiotherapy, and adding abiraterone to hormone therapy now lengthens life in the highest-risk men. Below, week by week, is what OnCo's record of Localised prostate cancer, high and very high risk says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
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.
- RadiologistNamed in the standard of care for: Very high risk and node-positive.
- SurgeonNamed in the standard of care for: High risk.
- Medical oncologistNamed in the standard of care for: High risk, Very high risk and node-positive, After prostatectomy with adverse pathology.
- Clinical oncologist (radiotherapy)Named in the standard of care for: High risk, Very high risk and node-positive, After prostatectomy with adverse pathology.
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.
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.
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.
Radiotherapy plus androgen deprivation with two years of abiraterone (STAMPEDE); PSMA PET staging before treatment.
Adjuvant or early salvage radiotherapy guided by PSA, with hormone therapy for higher-risk features.
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.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Localised prostate cancer, high and very high risk: the full pageHigh-risk prostate cancer has Grade Group 4 or 5 disease, a PSA above 20 or a tumour growing beyond the gland. It is still curable, but needs radiotherapy with two to three years of hormone therapy, or surgery followed by radiotherapy, and adding abiraterone to hormone therapy now lengthens life in the highest-risk men.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Biochemical recurrence (BCR): PSA rising again after surgery or radiation, usually years before anything shows on a scan.
- PSA (prostate-specific antigen): A blood protein made by the prostate; raised levels prompt further tests, and falling levels show treatment is working.
Every term links to the glossary.