The first 60 days: Prostate cancer
Prostate cancer is the home of theranostics: PSMA PET finds it, PSMA radioligands treat it. Hormonal therapy remains the foundation, with PARP and AKT inhibitors added by genotype. Below, week by week, is what OnCo's record of Prostate cancer 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.
- PSA, MRI-targeted biopsy with Gleason grading, and a PSMA PET-CT, which replaced bone scan and CT for staging (proPSMA).
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.
- PathologistNamed in the standard of care for: Localised, Screening, Localised, low / favourable-intermediate risk, Localised, unfavourable-intermediate / high risk.
- RadiologistNamed in the standard of care for: Localised, Metastatic hormone-sensitive, Castration-resistant, Screening and 6 more.
- SurgeonNamed in the standard of care for: Localised, Localised, low / favourable-intermediate risk, Localised, unfavourable-intermediate / high risk, Biochemical recurrence.
- Medical oncologistNamed in the standard of care for: Localised, Metastatic hormone-sensitive, Castration-resistant, Localised, low / favourable-intermediate risk and 6 more.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Localised, Castration-resistant, Localised, unfavourable-intermediate / high risk, Biochemical recurrence and 3 more.
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.
Shared-decision PSA testing from 50 (45 if Black or family history/BRCA), risk-adapted intervals; MRI before biopsy; avoid biopsy if MRI negative and PSA density low.
Active surveillance, prostatectomy, or radiation ± ADT (duration guided by risk/ArteraAI).
Active surveillance (PSA, MRI, repeat biopsy) for Grade Group 1 and many favourable GG2; genomic classifier or ArteraAI to refine.
Radical prostatectomy (robotic) or radiotherapy (hypofractionated IMRT, SBRT, or brachytherapy boost) with 4-6 months (intermediate) to 18-36 months (high risk) of ADT; abiraterone added for very high risk (STAMPEDE); ArteraAI predicts ADT benefit.
ADT + ARPI ± docetaxel; PSMA PET staging; capivasertib if PTEN-deficient.
PSMA PET to localise; salvage radiotherapy ± ADT after prostatectomy; metastasis-directed SBRT for oligorecurrence (investigational for survival); enzalutamide ± ADT for high-risk BCR (EMBARK).
ADT (GnRH agonist/antagonist, e.g., relugolix) + ARPI (abiraterone, enzalutamide, apalutamide, or darolutamide); add docetaxel for high-volume de novo disease (ARASENS, PEACE-1); add 177Lu-PSMA-617 if PSMA-positive (PSMAddition, approved 31 Jul 2026); capivasertib + abiraterone if PTEN-deficient (2026); prostate RT for low-volume disease.
Apalutamide, enzalutamide, or darolutamide (SPARTAN, PROSPER, ARAMIS); PSMA PET usually reclassifies as metastatic.
ARPI (if not used earlier); PARP inhibitor + ARPI for BRCA/HRR-mutant (olaparib-abiraterone, talazoparib-enzalutamide, niraparib-abiraterone); docetaxel; 177Lu-PSMA-617 after one ARPI before chemotherapy (PSMAfore); pembrolizumab if MSI-high.
ARPI switch, PARP inhibitor combinations (HRR+), 177Lu-PSMA-617, docetaxel/cabazitaxel, radium-223.
177Lu-PSMA-617 post-taxane (VISION); cabazitaxel (CARD); radium-223 for bone-only symptomatic disease (with bone protection); 225Ac-PSMA, xaluritamig, pasritamig, mevrometostat in trials; platinum-etoposide for neuroendocrine transformation; tarlatamab/I-DXd trials for DLL3/B7-H3.
- Radiotherapy with hormone therapy, or radical prostatectomy?
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 PSA, Gleason / Grade Group, PSMA PET, HRR genes, PTEN), 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 Localised: low / favourable-intermediate / unfavourable-intermediate / high risk, Non-metastatic castration-resistant, Metastatic hormone-sensitive, de novo vs recurrent, high vs low volume.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Localised
- For my situation (localised), which of the standard options do you recommend and why?Guideline options include: Active surveillance, prostatectomy, or radiation ± ADT (duration guided by risk/ArteraAI).
- Am I a candidate for ArteraAI Prostate, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Metastatic hormone-sensitive
- For my situation (metastatic hormone-sensitive), which of the standard options do you recommend and why?Guideline options include: ADT + ARPI ± docetaxel; PSMA PET staging; capivasertib if PTEN-deficient.
- Am I a candidate for Capivasertib, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Castration-resistant
- For my situation (castration-resistant), which of the standard options do you recommend and why?Guideline options include: ARPI switch, PARP inhibitor combinations (HRR+), 177Lu-PSMA-617, docetaxel/cabazitaxel, radium-223.
- Am I a candidate for Lutetium-177 vipivotide tetraxetan, Olaparib, Niraparib or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of VISION and PSMAfore apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Screening
- For my situation (screening), which of the standard options do you recommend and why?Guideline options include: Shared-decision PSA testing from 50 (45 if Black or family history/BRCA), risk-adapted intervals; MRI before biopsy; avoid biopsy if MRI negative and PSA density low.
- How do the results of PRECISION apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Localised, low / favourable-intermediate risk
- For my situation (localised, low / favourable-intermediate risk), which of the standard options do you recommend and why?Guideline options include: Active surveillance (PSA, MRI, repeat biopsy) for Grade Group 1 and many favourable GG2; genomic classifier or ArteraAI to refine.
- Am I a candidate for Decipher Prostate, ArteraAI Prostate, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of ProtecT apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Localised, unfavourable-intermediate / high risk
- For my situation (localised, unfavourable-intermediate / high risk), which of the standard options do you recommend and why?Guideline options include: Radical prostatectomy (robotic) or radiotherapy (hypofractionated IMRT, SBRT, or brachytherapy boost) with 4-6 months (intermediate) to 18-36 months (high risk) of ADT; abiraterone added for very high risk (STAMPEDE); ArteraAI predicts ADT benefit.
- Am I a candidate for ArteraAI Prostate, 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 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Biochemical recurrence
- For my situation (biochemical recurrence), which of the standard options do you recommend and why?Guideline options include: PSMA PET to localise; salvage radiotherapy ± ADT after prostatectomy; metastasis-directed SBRT for oligorecurrence (investigational for survival); enzalutamide ± ADT for high-risk BCR (EMBARK).
- Am I a candidate for Enzalutamide, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of EMBARK apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Metastatic hormone-sensitive (mAPMN/S)
- For my situation (metastatic hormone-sensitive (mapmn/s)), which of the standard options do you recommend and why?Guideline options include: ADT (GnRH agonist/antagonist, e.g., relugolix) + ARPI (abiraterone, enzalutamide, apalutamide, or darolutamide); add docetaxel for high-volume de novo disease (ARASENS, PEACE-1); add 177Lu-PSMA-617 if PSMA-positive (PSMAddition, approved 31 Jul 2026); capivasertib + abiraterone if PTEN-deficient (2026); prostate RT for low-volume disease.
- Am I a candidate for Abiraterone acetate, Enzalutamide, Apalutamide or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of ARASENS and PEACE-1 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Non-metastatic CRPC
- For my situation (non-metastatic crpc), which of the standard options do you recommend and why?Guideline options include: Apalutamide, enzalutamide, or darolutamide (SPARTAN, PROSPER, ARAMIS); PSMA PET usually reclassifies as metastatic.
- Am I a candidate for Apalutamide, Enzalutamide, Darolutamide, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Metastatic CRPC, first line
- For my situation (metastatic crpc, first line), which of the standard options do you recommend and why?Guideline options include: ARPI (if not used earlier); PARP inhibitor + ARPI for BRCA/HRR-mutant (olaparib-abiraterone, talazoparib-enzalutamide, niraparib-abiraterone); docetaxel; 177Lu-PSMA-617 after one ARPI before chemotherapy (PSMAfore); pembrolizumab if MSI-high.
- Am I a candidate for Olaparib, Talazoparib, Niraparib or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of PROpel and TALAPRO-2 apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Metastatic CRPC, later lines
- For my situation (metastatic crpc, later lines), which of the standard options do you recommend and why?Guideline options include: 177Lu-PSMA-617 post-taxane (VISION); cabazitaxel (CARD); radium-223 for bone-only symptomatic disease (with bone protection); 225Ac-PSMA, xaluritamig, pasritamig, mevrometostat in trials; platinum-etoposide for neuroendocrine transformation; tarlatamab/I-DXd trials for DLL3/B7-H3.
- Am I a candidate for Lutetium-177 vipivotide tetraxetan, Cabazitaxel, Radium-223 dichloride or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of VISION and ALSYMPCA apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Any stage
- Are there clinical trials I could join, for example of Actinium-225 PSMA agents, Ifinatamab deruxtecan, Capivasertib, Tarlatamab?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 “Overdiagnosis vs. underdiagnosis in screening”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Neuroendocrine transformation”. How does that affect my plan?Open problems are where trials and second opinions matter most.
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.
- [18F]Florastamin PET/CT Imaging Examination in Patients With Suspected Recurrent or Metastatic Prostate CancerPhase 3 · active · NCT05936658A Multi-center, Open-label, Single Arm Phase III Clinical Trial for the Diagnostic Efficacy Assessment and Safety Evaluation by [18F]Florastamin PET/CT Imaging Examination in Patients With Suspected Recurrent or Metastatic Prostate Cancer
- 64Cu-SAR-bisPSMA Positron Emission Tomography: A Phase 3 Study of Participants With Biochemical Recurrence of Prostate CancerPhase 3 · active · NCT0697084764Cu-SAR-bisPSMA Positron Emission Tomography: A Phase 3 Study of Participants With Biochemical Recurrence of Prostate Cancer
- A Clinical Study of Ifinatamab Deruxtecan (I-DXd) in People With Metastatic Prostate Cancer (MK-2400-001)Phase 3 · recruiting · NCT06925737A Phase 3, Open-label Study of Ifinatamab Deruxtecan Versus Docetaxel in Participants With Metastatic Castration-Resistant Prostate Cancer (mCRPC) (IDeate-Prostate01)
- A Multicenter, Randomized, Double-Blind, Placebo-Controlled Phase III Study of Fuzuloparib Combined With Abiraterone Acetate and Prednisone (AA-P) VerPhase 3 · active · NCT04691804A Multicenter, Randomized, Double-Blind, Placebo-Controlled Phase III Study of Fuzuloparib Combined With Abiraterone Acetate and Prednisone (AA-P) Versus Placebo Combined With AA-P as First-Line Treatment in Patients With Metastatic Castration-Resistant Prostate Cancer
- A Phase III Clinical Study of Rezvilutamide in Patients With Metastatic Hormone-Sensitive Prostate CancerPhase 3 · recruiting · NCT07241416A Multicenter, Randomized, Open-Label, Positive-Controlled Phase III Study of Rezvilutamide Combined With Androgen Deprivation Therapy (ADT) Versus Enzalutamide Combined With ADT for Treating Low-volume Metastatic Hormone Sensitive Prostate Cancer (mHSPC)
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Prostate cancer: the full pageProstate cancer is the home of theranostics: PSMA PET finds it, PSMA radioligands treat it. Hormonal therapy remains the foundation, with PARP and AKT inhibitors added by genotype.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment journey: High-risk localisedRadiotherapy with two to three years of hormone therapy (sometimes with abiraterone), or surgery, after a PSMA PET scan has shown the cancer has not spread; then PSA checks for life.
- Guidelines comparedNCCN, ESMO and NICE side by side for this cancer.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Crossover in trials: When patients in a trial's control arm are allowed to switch to the experimental drug after their cancer progresses.
- Androgen receptor pathway inhibitor (ARPI): The newer prostate cancer hormone pills (abiraterone, enzalutamide, apalutamide, darolutamide) that block the androgen receptor or the last steps of androgen production, used on top of standard testosterone suppression.
- Radical prostatectomy: Removing the entire prostate gland and seminal vesicles for localised prostate cancer, now almost always with a robot.
- PSA50 / PSA90 response: PSA50 is the share of patients whose PSA falls by at least half on treatment, and PSA90 the share whose PSA falls by 90%.
- Orchiectomy: Surgical removal of a testicle: the diagnostic and first curative step for testicular cancer, or of both, as a cheap permanent form of hormone therapy in prostate cancer.
- Hormone therapy: Treatment that starves cancers which grow in response to a hormone, mainly oestrogen in breast cancer and testosterone in prostate cancer, by lowering the hormone or blocking its receptor.
- mCRPC and mHSPC (castration-resistant vs hormone-sensitive prostate cancer): Prostate cancer starts out fed by testosterone (hormone-sensitive) and shrinks when it is removed.
- Androgen deprivation therapy (ADT): Switching off testosterone, the hormone that feeds prostate cancer, with injections (or tablets) that stop the testicles making it, or by removing them.
- Biochemical recurrence (BCR): PSA rising again after surgery or radiation, usually years before anything shows on a scan.
- AR-V7 splice variant: A truncated form of the androgen receptor that is permanently switched on and ignores hormone-blocking pills.
Every term links to the glossary.