Just diagnosed with Prostate Cancer — what should I do first

Your First Steps After a Prostate Cancer Diagnosis

I'm glad you're taking action right away. Here's what you should focus on initially, based on current medical guidelines:

1. Understand Your Specific Diagnosis

According to the NCCN Guidelines for Patients: Early-Stage Prostate Cancer, your care team needs to gather complete information about your cancer to determine your risk level. Ask your doctor for:

• Your Gleason score (how aggressive the cancer cells look under a microscope)
• Your PSA level (prostate-specific antigen, a blood test that measures cancer activity)
• The stage of your cancer (whether it's confined to the prostate or has spread)
• Any imaging results (MRI, bone scans, or other tests showing if cancer has spread)

This information helps determine whether you have lower-risk or higher-risk cancer, which directly affects your treatment options.

2. Get a Complete Medical Workup

Your care team should perform:

• Digital rectal exam (your doctor feels the prostate to check its size and texture)
• Biopsy confirmation (if not already done—tissue samples confirm the diagnosis)
• Imaging tests (to see if cancer has spread beyond the prostate)
• General health assessment (your age, overall health, and other medical conditions matter for treatment decisions)

3. Ask About Your Treatment Options

According to NCCN Guidelines, the key questions to ask your oncology team are:

1. What are my treatment options?
2. Is a clinical trial an option for me?
3. What will happen if I do nothing? (This is especially important for lower-risk cancers—many men benefit from "active surveillance" rather than immediate treatment)
4. How do my age, overall health, and other factors affect my options?
5. Does any option offer a cure or long-term cancer control?
6. What are the side effects of each treatment?
7. How long do I have to decide about treatment?
8. How do I get a second opinion?

4. Understand Your Risk Category

The NCCN emphasizes that overtreatment is a real concern in early-stage prostate cancer. Doctors are concerned about treating cancers that may never cause harm. Your risk level determines urgency:

• Lower-risk cancer: Active surveillance (careful monitoring without immediate treatment) may be appropriate
• Higher-risk cancer: More aggressive treatment is typically recommended

5. Build Your Care Team

Ask potential doctors:

• Are you board certified? In what specialty?
• What's your experience treating prostate cancer patients like me?
• How many patients have you treated with my type of cancer?
• How often do you perform this treatment or procedure?
• What complications have your patients experienced?

This is critical: You want a genitourinary (GU) medical oncologist—a specialist focused specifically on prostate cancer—as part of your team.

6. Consider Genetic Testing

Ask your doctor about:

• Tumor genetic testing (DNA/RNA sequencing of your cancer cells to identify mutations that might respond to specific drugs)
• Germline testing (checking if you have inherited cancer risk genes like BRCA1 or BRCA2)

According to the webinar "Update on Prostate Cancer Treatments," genetic testing identifies actionable treatments for about 20% of prostate cancer patients.

7. Take Time to Decide

You likely have time. Unless your doctor indicates otherwise, you don't need to rush into treatment immediately. Use this time to:

• Get a second opinion
• Understand your options fully
• Ask questions until you feel confident
• Consider whether a clinical trial might be right for you

What NOT to Do Right Now

• Don't assume you need immediate surgery or radiation
• Don't make decisions based on fear alone
• Don't skip the genetic testing conversation
• Don't ignore the possibility of active surveillance if you have lower-risk disease

Key Takeaway

According to NCCN Guidelines, the most important first step is accurate risk stratification—understanding exactly what type of prostate cancer you have. This determines everything else. Once you know your risk level, your treatment options become much clearer.

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Questions to bring to your next appointment:

• What is my Gleason score and PSA level?
• What stage is my cancer?
• What is my risk category (lower, intermediate, or higher risk)?
• Should I consider active surveillance?
• Am I a candidate for genetic testing?
• Can you refer me to a GU medical oncologist for a second opinion?

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.