What the diagnosis means
Prostate cancer is graded by the Gleason score / Grade Group on the biopsy and staged with PSA, MRI and — for higher-risk disease — bone scan and CT or PSMA PET-CT. Many prostate cancers grow slowly for years; others spread early, most often to bone and lymph nodes. Risk group (low, intermediate, high) and whether the cancer has spread decide the approach.
Where medical oncology fits
- Low-risk localised disease: active surveillance — regular PSA, MRI and repeat biopsy — with treatment only if the cancer changes. Avoiding over-treatment is a genuine option here.
- Localised or locally advanced disease: surgery (radical prostatectomy) by a urologist, or radiation by a radiation oncologist, often with a period of hormone therapy for higher-risk disease.
- Metastatic disease: medical oncology leads. Androgen-deprivation therapy (lowering testosterone) is the backbone, now usually combined early with a newer hormonal agent and, for some men with high-volume disease, chemotherapy. When the cancer progresses despite low testosterone ("castration-resistant"), options include further hormonal agents, chemotherapy, PARP inhibitors for men with BRCA and related mutations, and radioligand therapy where available.
Genetic testing (germline and tumour) is recommended for metastatic and high-risk disease.
Living with hormone therapy
Hot flushes, tiredness, loss of muscle, weight gain, reduced libido and erectile changes, mood changes, and over time weaker bones and higher cardiovascular and diabetes risk are expected effects. They are manageable: exercise, bone-protecting medicines, monitoring of blood sugar and cholesterol, and honest conversation about sexual health are part of the plan.
Questions to ask
- What is my Grade Group and risk category, and is surveillance a safe option?
- If treatment is needed: surgery, radiation, or both — and is hormone therapy required?
- For advanced disease: which combination is recommended for me, and why?
- Has genetic testing been arranged?
- How will bone health, heart health and sexual function be protected?
Preparing for your consultation
Bring PSA history, the biopsy report with Gleason/Grade Group, MRI and any bone scan or PSMA PET reports, urinary symptom history, and a medicine list. Note any family history of prostate, breast, ovarian or pancreatic cancer.