A step-by-step guide for men in the first days and weeks after a prostate cancer diagnosis. You are not alone — and you have more time than you think.
“The most important thing I can tell you right now is this: breathe. Prostate cancer is almost never a medical emergency. You have time to learn, to ask questions, and to make a thoughtful decision.”
Understand What You Are Actually Facing
A prostate cancer diagnosis is frightening — but it is not a death sentence. The five-year survival rate for localized prostate cancer is nearly 100%. The vast majority of men diagnosed with prostate cancer will not die from it.
Your pathology report contains three critical numbers: your PSA level, your Gleason score (or Grade Group), and your clinical stage. These three numbers together determine your risk category and guide your treatment options.
| Gleason Score | Grade Group | Risk Category |
|---|---|---|
| 6 (3+3) | 1 | Low — active surveillance often appropriate |
| 7 (3+4) | 2 | Intermediate-Favorable |
| 7 (4+3) | 3 | Intermediate-Unfavorable |
| 8 (4+4) | 4 | High — treatment required |
| 9–10 | 5 | Very High — aggressive treatment required |
Get a Second Opinion Before Making Any Decision
Before you agree to any treatment, get a second opinion from a different urologist or oncologist — ideally at a major cancer center. This is standard practice, and any good physician will encourage it. A second opinion may confirm your first doctor’s recommendation — or offer a different perspective on your options.
Consider genomic testing: tests such as Oncotype DX, Decipher, and Prolaris can provide additional information about your cancer’s aggressiveness beyond the Gleason score. Ask your urologist if genomic testing is appropriate for your case.
Understand Active Surveillance
For men with low-risk prostate cancer (Gleason 6 / Grade Group 1), active surveillance — carefully monitoring the cancer without immediate treatment — is now the recommended approach at most major cancer centers. It is not “doing nothing.” It is a structured program of regular PSA tests, digital rectal exams, and periodic biopsies.
Active surveillance avoids the side effects of treatment for as long as possible, while ensuring that if the cancer progresses, it is caught early enough to treat effectively.
Compare Your Treatment Options
| Treatment | Best For | Main Side Effects |
|---|---|---|
| Active Surveillance | Low-risk, older men | Anxiety; ongoing monitoring |
| Radical Prostatectomy | Younger, healthy men | Incontinence, ED (often temporary) |
| External Beam Radiation | All risk categories | Bowel/urinary changes; ED (delayed) |
| Brachytherapy | Low/intermediate risk | Urinary symptoms; ED |
| Hormone Therapy (ADT) | High-risk; with radiation | Hot flashes, fatigue, bone loss |
20 Questions to Ask Your Doctor
- What is my Gleason score and Grade Group?
- What is my clinical stage (T, N, M)?
- What is my PSA level, and what does it mean for my risk category?
- Am I a candidate for active surveillance?
- What are my treatment options given my specific diagnosis?
- What are the short-term and long-term side effects of each option?
- How will each treatment affect my urinary function?
- How will each treatment affect my sexual function?
- Am I a candidate for nerve-sparing surgery?
- Should I consider genomic testing (Oncotype DX, Decipher, Prolaris)?
- Do you recommend I get a second opinion?
- Are there any clinical trials I should know about?
- How experienced are you with this specific treatment?
- What is your personal complication rate for this procedure?
- What happens if I choose treatment and the cancer comes back?
- How often will I need follow-up PSA testing?
- What lifestyle changes should I make now?
- Are there any supplements or dietary changes that could help?
- What support resources do you recommend for me and my family?
- What does my survivorship care plan look like?