Localised prostate cancer, high and very high risk
Prepared with OnCo (onco.cc/prep/prostate-high-risk/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
16 on the sheet- 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 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?
- 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?
- 5.For my situation (high risk), which of the standard options do you recommend and why?
- 6.Am I a candidate for Leuprolide (leuprorelin) and GnRH agonists, Degarelix, Relugolix, and what side effects should I expect?
- 7.How do the results of HYPO-RT-PC apply to someone like me?
- 8.For my situation (very high risk and node-positive), which of the standard options do you recommend and why?
- 9.Am I a candidate for Abiraterone acetate, and what side effects should I expect?
- 10.How do the results of STAMPEDE and proPSMA apply to someone like me?
- 11.For my situation (after prostatectomy with adverse pathology), which of the standard options do you recommend and why?
- 12.Are there clinical trials I could join, for example of PSMA PET, ArteraAI Prostate, Decipher Prostate, Abiraterone acetate?
- 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 “How long hormone therapy should last when abiraterone is added”. How does that affect my plan?
- 16.I read that “Whether PSMA PET-detected nodes should change treatment when the trials were staged conventionally”. How does that affect my plan?
The words I may hear
- 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.
Tests and results to bring
Biomarker results to ask for: Gleason Grade Group 4 or 5, PSA above 20 ng/mL, PSMA PET staging, Germline and tumour HRR testing (BRCA2 in particular), Decipher genomic classifier.
Scans and tests linked to this cancer: Active surveillance, PSMA PET, 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
- High risk: 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. (IMRT / IGRT (modern external beam), Androgen deprivation & AR pathway inhibitors, Leuprolide (leuprorelin) and GnRH agonists, Degarelix, Relugolix, Brachytherapy, Robotic & minimally invasive surgery, HYPO-RT-PC)
- Very high risk and node-positive: Radiotherapy plus androgen deprivation with two years of abiraterone (STAMPEDE); PSMA PET staging before treatment. (Abiraterone acetate, STAMPEDE, PSMA PET, proPSMA)
- After prostatectomy with adverse pathology: Adjuvant or early salvage radiotherapy guided by PSA, with hormone therapy for higher-risk features. (IMRT / IGRT (modern external beam), Androgen deprivation & AR pathway inhibitors, PSA (prostate-specific antigen), Biochemical recurrence (BCR))
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.