June 30, 2025

Prostate Cancer Diagnosis? 3 Critical Questions to Ask Your Doctor

Receiving a prostate cancer diagnosis can feel like a punch to the gut, instantly transforming your world into a whirlwind of uncertainty and fear. In the moment, it's normal to feel overwhelmed, leaving crucial questions unasked. However, arming yourself with knowledge is one of the most potent tools in navigating this journey. As you prepare for your next appointment with your urologist, remember that this is your opportunity to gain clarity and actively participate in making informed decisions about your treatment. To help you feel more prepared and confident, we'll delve into three critical questions for your urologist after receiving a prostate cancer diagnosis.

Which tests confirm whether prostate cancer has spread outside the prostate?

The most advanced and newest way of testing for the spread of prostate cancer is a specific type of PET CT called a PSMA PET CT. This imaging study utilizes a specific radioisotope that can recognize and bind to prostate cancer cells throughout the body. Once the radionuclide accumulates in areas containing prostate cancer cells, then the scan will identify locations in the body that are "hotspots." If the hotspots are outside the prostate, then there is an indication for metastasis or spread of prostate cancer.

Other studies, which may also help identify prostate cancer spread, include CT scans, whole-body bone scans, and MRIs of the prostate. Furthermore, if a patient's PSA (prostate-specific antigen) is markedly elevated, then there is also an extremely high likelihood that cancer has spread beyond the prostate. Understanding these test results and their implications is crucial for making informed decisions about your treatment plan.

When is active surveillance considered the best approach versus immediate treatment?

Active surveillance is recommended for types of prostate cancer that are unlikely to propagate rapidly and spread. When the cancer is found in lower stages, a small volume, low-grade PSA is usually less than 10. “Low stage” means that the cancer is confined to the prostate. In low-stage prostate cancer, there is no evidence of cancer extending beyond the capsule of the prostate, and there is no evidence of cancer spreading to other locations in the body.

“Low grade” means that the prostate cancer is not very aggressive and is extremely slow-growing. The grading of prostate cancer is based on the Gleason score. The Gleason score is assigned based on the architectural pattern of the cancer cells when examined under a microscope. The lowest Gleason score is 3+3, which indicates that prostate cancer is non-aggressive. A high Gleason score is 5+5, which means a most aggressive form of prostate cancer. A physician may offer active surveillance as a treatment option to men with a Gleason score of 3+3. Some low-volume Gleason 3+4 cancers may also be eligible for active surveillance.

The “volume” of prostate cancer is indicated by how much cancer has been found in the prostate based on biopsy, MRI, and PSMA PET scan. Generally, 12 regions of the prostate are biopsied when investigating the potential for prostate cancer. If only one to three regions of the total of 12 areas show cancer, low-volume prostate cancer is the indication.

Furthermore, the percentage of cancer within each location also makes a difference. Therefore, the smaller the amount of cancer in the prostate, the more likely it is that active surveillance is a viable option. Over the past few years, molecular testing studies have also been developed to help predict the likelihood of cancer progression while a patient is on active surveillance. These studies can also help determine which men with prostate cancer are good candidates for such an approach.

When should a patient consider getting a second opinion?

A second opinion is always a good idea. Even when a patient agrees with treatment recommendations, if they don't feel a generally positive connection with their doctor, if they feel rushed, or have noticed that their concerns are not being addressed, then it is also crucial to obtain a second opinion. A second opinion can be obtained by consulting with another urologist who specializes in oncology or by meeting with a medical oncologist or a radiation oncologist.

Navigating a prostate cancer diagnosis is a journey, and the above three critical questions are just the starting point. Remember, your urologist is not just a medical professional but your partner in this process. They are there to guide you, answer your questions, and help you make the best decisions for your health. Don't hesitate to ask follow-up questions, seek clarifications, or seek a second opinion to ensure you feel fully informed and confident in your treatment plan. By actively participating in discussions about your diagnosis, treatment options, and the potential impact on your quality of life, you empower yourself to make informed decisions for your health and well-being.

Sources:
Dr. Ramin’s email answers provided on 6/11/25.