Q&A’s for Someone Just Diagnosed with Prostate Cancer

When someone is just diagnosed with prostate cancer, they often have a range of questions and concerns. The specific questions may vary from person to person, but here are some frequent questions and answers that individuals diagnosed with prostate cancer might find useful:

  1. What stage is my prostate cancer? Understanding the stage of the cancer is crucial for determining the most appropriate treatment options and overall prognosis.
  2. What are my treatment options? Patients often want to know about the available treatment options, including surgery, radiotherapy, hormone therapy, chemotherapy, immunotherapy and active surveillance.
  3. What are the potential side effects of treatment? Different treatments can have various side effects and patients may want to know what to expect.
  4. What is the prognosis? Patients often want to know about their long term outlook and survival rates associated with their stage and type of prostate cancer.
  5. Is a second opinion necessary? Many patients seek a second opinion to confirm the diagnosis and explore additional or alternate treatment options.
  6. What lifestyle changes can I make? Questions about diet, exercise and overall lifestyle changes are common.
  7. How will this affect my daily life? Patients may have concerns about how prostate cancer and its treatment will impact their daily routines, work and quality of life.
  8. What is the timeline for treatment and recovery? Understanding the timing of treatment and recovery can help patients plan their lives accordingly.
  9. What support resources are available to me? Patients may enquire about support groups, counselling or other resources to help them cope with the emotional and psychological aspects of a cancer diagnosis.
  10. How often will I need follow-up appointments and tests? Patients want to know about the recommended schedule for monitoring their condition after treatment.

It’s essential for individuals diagnosed with prostate cancer to have open and frank discussions with their healthcare team to address these and any other questions or concerns they may have. Additionally, seeking emotional support from friends and family and local support groups can be beneficial during this challenging time.

Prostate Cancer
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What stage is my prostate cancer at?

The stage of prostate cancer is typically determined through a series of medical tests and assessments conducted by your consultant urologist. These tests may include:

  1. Digital Rectal Examination (DRE): A physical examination of the prostate gland through the rectum to check for abnormalities.
  2. Prostate-Specific Antigen (PSA) Test: A blood test that measures the level of PSA in the blood. Elevated PSA levels can be a sign of prostate cancer or other conditions.
  3. Transrectal Ultrasound (TRUS): A procedure in which a probe is inserted into the rectum to create images of the prostate.
  4. Imaging Tests: These may include MRI, CT scans, bone scans, and other imaging studies to assess the extent and location of the cancer.
  5. A Prostate Biopsy: A tissue sample is taken from the prostate to confirm the presence of cancer and determine its grade. It is now quite common to have an MRI before a biopsy.

Based on the results of these tests and assessments, your healthcare team will determine the stage of your prostate cancer. Prostate cancer staging is typically expressed on a scale from 0 (very early stage) to IV (advanced prostate cancer stage) and it takes into account factors such as the size and location of the tumour, whether it has spread to nearby lymph nodes or distant organs, and the Gleason score, which is a measure of how aggressive the cancer cells appear under a microscope.

It’s important to openly discuss your specific case and its stage with your healthcare team, as they can provide you with the most up to date and relevant information about your diagnosis and treatment options available to you.

What are my treatment options?

The choice of treatment for prostate cancer depends on various factors, including the stage and grade of the cancer, your age, overall health and your personal preferences. Here are some common treatment options for prostate cancer:

  1. Active Surveillance; This approach involves monitoring the cancer without any immediate treatment. It’s typically considered for low-risk prostate cancer and if the cancer progresses, active treatment can then be initiated.
  2. Surgery; Prostatectomy is the surgical removal of the prostate gland. This can be done using traditional open surgery, laparoscopic techniques or robot-assisted surgery (robotic prostatectomy, DaVinci).
  3. Radiotherapy; Radiation can be used to kill cancer cells or slow their growth. It can be delivered through external beam radiation or brachytherapy, which is the implanting of radioactive seeds directly into the prostate.
  4. Hormone Therapy; Hormone therapy, also known as androgen deprivation therapy, is used to reduce the level of male hormones (androgens) that fuel the growth of prostate cancer cells. This can be done with medications or surgical removal of the testicles.
  5. Chemotherapy; This may be used for advanced prostate cancer that has spread to other parts of the body. It is typically not used as the first-line treatment.
  6. Immunotherapy; This is one of the newer type of treatments. Immunotherapies are designed to help the immune system attack cancer cells.
  7. Targeted Therapy; This uses newer and sometimes novel drugs that specifically target certain molecules involved in cancer cell growth. They are often used in combination with other treatments for advanced prostate cancer.
  8. Cryotherapy; This involves freezing and killing cancer cells in the prostate. It is used in some cases for treating localised or recurrent cancer.
  9. High-Intensity Focused Ultrasound (HIFU); HIFU uses focused ultrasound waves to destroy prostate tissue. It is used in some cases to treat localised prostate cancer.
  10. Bone-Directed Treatment; If the cancer has spread to the bones (metastasis), treatments like bisphosphonates (Fosamax, Actonel) or denosumab (Xgeva, Prolia) may be used to strengthen bones and reduce the risk of fractures.

Your healthcare team will consider the stage and grade of your cancer, your overall health, and your personal preferences when recommending a treatment. It’s important to have a detailed, open discussion with your healthcare provider to understand the pros and cons of each treatment. In many cases, a multidisciplinary approach involving various specialists is used to provide the best treatment options. [back to top]

What are the potential side effects of treatment?

 The possible side effects of prostate cancer treatment can vary depending on the type of treatment and individual factors. It’s important to discuss these potential side effects with your healthcare team before beginning treatment. Here are some common side effects associated with different kinds of prostate cancer treatment;

Surgery (Prostatectomy):

  • Incontinence; Some degree of urinary incontinence can occur, but it is often temporary. Incontinence may improve over time or require treatment.
  • Erectile Dysfunction (Impotence); Surgery can lead to difficulties with achieving or maintaining erections. Recovery can vary, and treatments are available to address this issue.
  • Bowel Problems; Rarely, surgery can lead to bowel problems such as diarrhoea or rectal leakage.

Radiotherapy:

  • Constant Tiredness; Many patients undergoing radiotherapy experience fatigue which can affect motivation and daily activities.
  • Urinary Problems; Radiation can irritate the bladder and cause urinary symptoms like increased frequency and urgency or discomfort.
  • Bowel Changes; Radiation may also affect the rectum, leading to diarrhoea, bleeding and general discomfort.
  • Erectile Dysfunction; Like surgery, radiotherapy can lead to erectile dysfunction over time.
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Hormone Therapy:

  • Hot Flashes; Many men on hormone therapy may experience hot flashes and sweats.
  • Lower Libido; Hormone therapy can lead to a decreased interest in sexual activity.
  • Persistent Tiredness; Some individuals may experience prolonged fatigue or an overall sense of weakness while on hormone therapy.
  • Osteoporosis; Long-term use of hormone therapy can make bones more brittle and increase the risk of fractures.

Chemotherapy:

  • Nausea and Vomiting; Chemotherapy commonly causes nausea and vomiting. There are supplementary medications can help manage these side effects.
  • Fatigue; In common with other treatments chemotherapy can lead to fatigue or weakness.
  • Lower Blood Cell Counts; Chemotherapy can reduce the number of red and white blood cells and platelets, increasing the risk of anaemia, infection, and bleeding.

Immunotherapy and Targeted Therapy: These treatments may have side effects that vary depending on the specific drugs used but can include fatigue, rashes, diarrhoea and immuno-related side effects such as inflammation in various organs.

Cryotherapy and HIFU: Side effects can include erectile dysfunction and in rare cases urinary incontinence or rectum injury.

Bone-Directed Treatment: Supplementary medication like bisphosphonates (Fosamax, Actonel) or denosumab (Xgeva, Prolia) can have side effects such as ‘flu like’ symptoms and joint pain.

It is important to note that not all patients will experience all these side effects and the severity of symptoms can vary. Your healthcare team will work with you to manage side effects and discuss potential ways to minimise them. Additionally, some side effects are temporary while others may persist after treatment. Your specific treatment pathway and its potential side effects will be discussed in detail prior to treatment. [back to top]

What is the prognosis?

The prognosis for prostate cancer varies significantly based on several factors and the stage of the cancer at diagnosis; the Gleason score (a measure of how aggressive the cancer cells appear), the patient’s overall health and the chosen treatment. Prostate cancer is generally associated with a favourable prognosis particularly when it is diagnosed at an early stage. Here are some key points to consider regarding the prognosis for prostate cancer:

  1. Localised Prostate Cancer (Stages I and II); When prostate cancer is detected at an early stage and is confined to the prostate gland the prognosis is often excellent. Many men with localised prostate cancer can achieve long term survival and may not experience significant disease progression. Treatment options such as surgery and radiotherapy can be curative.
  2. Locally Advanced Prostate Cancer (Stage III); Prostate cancer that has extended beyond the prostate but has not spread to distant organs can still have a favourable outlook. Treatment may include a combination of radiotherapy, hormone therapy and sometimes surgery can help control the disease and extend survival.
  3. Metastatic Prostate Cancer (Stage IV); When prostate cancer has spread to distant organs particularly the bones the prognosis becomes more challenging. However, advances in treatment, including new drugs and therapies, have improved the outlook for some men whose disease is metastatic. Treatment may focus on managing symptoms, slowing the progression of the cancer and extending life.
  4. Gleason Score; The Gleason score assesses the aggressiveness of the cancer cells and is a main factor in the prognosis. A higher Gleason score indicates more aggressive cancer and may be associated with a less favourable prognosis.
  5. Age and Overall Health; The age and overall health of the patient can influence the prognosis. Younger, healthier individuals may be better able to tolerate and respond to treatment.
  6. Responsiveness Treatment; The response to treatment varies from person to person. Some patients may have a complete response to treatment whilst others may experience disease progression. Advances in treatment options have expanded the choices for managing the disease including more effective therapies during advanced stages.
  7. Ongoing Monitoring; Prostate cancer often requires ongoing monitoring even when the cancer is not curable. It can often be managed for an extended periods with the tailored treatments and medical supervision.

It is important to constantly review your specific case including the stage, grade and treatment. Your medical team can provide you with a more accurate prognosis based on your circumstances and guide you through the ongoing treatment options. Additionally, maintaining a healthy lifestyle, adhering to recommended treatments and attend regular follow up appointments can positively impact your prognosis and overall quality of life. [back to top]

Is a second opinion necessary?

While a second opinion for prostate cancer is not always necessary it can be a valuable and prudent step especially when making important decisions about diagnosis and treatment. Here are some reasons to consider seeking a second opinion for prostate cancer:

  1. Confirmation of your Diagnosis; A second opinion can help confirm the accuracy of your initial diagnosis. This is particularly important as prostate cancer is a complex disease with numerous stages and grades. Ensuring an accurate diagnosis is essential for making informed treatment decisions.
  2. Treatment Decisions; Different healthcare providers may have differing views on the best treatment approach for your specific case. Seeking a second opinion can provide you with a broader range of treatment options to consider, allowing you to make a more informed choice.
  3. Validate you Treatment Plan; If your consultant recommends a specific treatment plan, a second opinion can validate the proposed course of action. It can help ensure that you are receiving the most appropriate ‘up to date’ treatment for your situation.
  4. Clinical Trial Eligibility; If you are interested in participating in clinical trials or experimental treatments, a second opinion can help you identify appropriate trials and whether they are going to be suitable for your condition.
  5. Peace of Mind; Prostate cancer diagnosis can be emotionally challenging, and seeking a second opinion can provide peace of mind. It can reduce uncertainty and increase your confidence in your treatment decisions.
  6. Complex or Unusual Cases; If your case is complex or has unusual features, it may be especially beneficial to consult with experts who have experience in managing such cases.
  7. Loved Ones Comfort; Sometimes, a second opinion is sought to provide reassurance to family members or to alleviate a patient’s anxiety regarding their diagnosis and treatment plan.

When seeking a second opinion it is advisable to choose a medical team with expertise in prostate cancer and one that is not affiliated with your current care team to avoid any potential conflicts of interest. Your primary health provider should be understanding and supportive of your decision to seek a second opinion.

Ultimately, whether to seek a second opinion is a personal choice and it is essential to make decisions that align with your feelings and preferences. Discuss your intentions with your current healthcare team as they can provide guidance and even help facilitate the process of obtaining a second opinion. [back to top]

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What lifestyle changes can I make?

Making certain lifestyle changes can be beneficial in supporting cancer recovery and your overall wellbeing. It is important that these changes should complement your medical treatment plan and should be discussed with your healthcare team. Here are some lifestyle changes that can help support cancer recovery:

Diet:

  • Nutrient-Rich Foods; Focus on a diet rich in fruits, vegetables, whole grains, and lean proteins and healthy fats. These foods can provide essential nutrients and support your immune system. Try not add highly processed dips and sauces.
  • Hydration; Stay well hydrated by drinking plenty of water throughout the day.
  • Moderate Alcohol; Limit or avoid alcohol as it may interfere with treatment and recovery.

Regular Exercise:

  • It often requires additional effort as your energy levels may be reduced. Exercise can improve strength, reduce tiredness and will enhance your overall sense of wellbeing.
  • Consult with your healthcare team to determine a suitable exercise plan based on your current physical and mental health and your treatment plan.

Manage Stress:

  • Consider stress-reduction techniques such as mindfulness, yoga, deep breathing exercises and relaxation therapy to help manage stress and anxiety.
  • Join local and online support groups or seek counselling /CBT (Cognitive behavioural therapy) to help address emotional and psychological aspects of cancer recovery.

Adequate Rest:

  • Ensure you get enough sleep and rest to support your body’s healing processes. If you are experiencing sleep disturbances discuss this with your healthcare provider.

Stick To Your Medication Regime:

  • Adhere to your prescribed medications and treatment plan as directed by your healthcare team. This is crucial for effective cancer management.

Manage Side Effects:

  • Talk openly and honestly with your healthcare team about any side affects you are experiencing with treatment. They can help you manage these effects and adjust treatment if necessary.

Non-Clinical Support Network:

  • Maintain connections with friends and family as a strong support system can be essential during recovery.
  • Consider joining cancer support groups or seeking therapy to connect with others who are going through similar experiences.

Have Regular Check Ups:

  • Attend all follow up appointments with your consultant to monitor your progress and address any concerns you may have.

Avoid Smoking:

  • If you are a smoker try to stop. Smoking can have a negative impact on your health and recovery.

Limit Exposure to Polluting Environments:

  • Minimise exposure to environmental toxins and pollutants that may contribute to cancer risk, such as second hand smoke or high traffic built-up areas.

Be Positive:

  • A positive attitude and a sense of hope can be powerful tools in your recovery. Enjoy the moment and live in the present. Surround yourself with positive influences and engage in activities that you enjoy.

It is important to work closely with your clinical team and support network. Cancer recovery is a complex and individualised process and your healthcare provider can offer guidance and support to help you make the most appropriate and effective changes for your situation. [back to top]

How will this affect my daily life?

Cancer can have a significant impact on various aspects of daily life, including physical, emotional, social and practical aspects. The extent and nature of this impact can vary depending on factors such as the stage of the prostate cancer, treatment plan and your individual circumstances. Here are some ways that your daily life can be affected:

Physical Effects:

  • Persistent Tiredness; Cancer related fatigue is a common and often debilitating symptom that can interfere with daily lives.
  • Pain; Depending on the stage of cancer, pain can be a prominent issue that requires specific management.
  • Treatment Side Effects; Treatments such as chemotherapy, radiotherapy and surgery can cause a range of side effects that impact daily life. These may include nausea, vomiting, hair loss and changes in appetite which can also lead to mental health issues that will require additional management.

Emotional and Psychological Effects:

  • Anxiety and Depression; A prostate cancer diagnosis can naturally lead to increased anxiety and depression. Coping with uncertainty and the emotional toll of the illness can be challenging.
  • Stress: The stress associated with managing treatment, side effects and the impact on daily routines can be significant.
  • Body Image and Self Esteem; Changes in physical appearance due to cancer or its treatment may affect self-esteem and body image.
  • Fear of Recurrence; The fear of the cancer returning after treatment is a common concern that can affect daily life, long term plans and overall emotional wellbeing.

Social Impact:

  • Relationships; Prostate cancer can strain relationships with family and friends. It frequently impacts the dynamics of intimate relationships.
  • Social Isolation; Some individuals with prostate cancer may experience social isolation due to physical limitations and emotional distress.
  • Work and Finances; Many people may need to take time off work during treatment which can affect finances and self-worth.

Practical Effects:

  • Medical Appointments: Cancer treatment often involves frequent medical appointments which can disrupt daily routines and require logistical planning.
  • Medication Management: Keeping track of multiple medications and dealing with side effects can be time-consuming and may require lifestyle adjustments.
  • Coping Strategies: Managing the emotional and practical challenges of prostate cancer may involve developing coping strategies and seeking support from primary care, local prostate cancer support groups or professional therapy.

Quality of Life:

  • Cancer and its treatment can affect your overall quality of life, impacting the ability to engage in hobbies, interact with friends and carry out daily activities.

It’s important to recognise that while cancer can bring significant challenges and changes, many individuals find ways to adapt and maintain a fulfilling life during and after treatment. Support from your consultant and their team, professional counsellors, local support groups and loved ones can play a crucial role in helping individuals navigate the challenges and improve their daily life. Additionally, advancements in cancer treatment and the increase in comprehensive support services continue to enhance the quality of life for cancer survivors. [back to top]

What is the timeline for treatment and recovery?

The timeline for prostate cancer treatment and recovery can vary significantly from one individual to another. It depends on several factors including the stage of the cancer, the type of treatment chosen and the patient’s overall health. Here is a general overview of the typical timeline for prostate cancer treatment and recovery:

Diagnosis and Initial Assessment:

  • The process begins with a diagnosis, which may involve a prostate biopsy, imaging tests and a physical examination.
  • Typically, within a few weeks of diagnosis, the patient and their healthcare team will discuss treatment options and develop a personalised treatment plan.

Treatment Decisions:

  • The patient and their healthcare team will discuss the various treatment options and make decisions based on the stage and grade of the cancer combined with the patient’s current health and preferences.
  • The timeframe for decision making varies, but generally takes place within a few weeks to a couple of months after diagnosis.
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Treatment Initiation:

  • The timing of treatment initiation depends on the chosen treatment modality and the healthcare system. Treatment may begin within a few weeks to a few months after the decision is made.

Active Treatment Phase: The duration of active treatment can vary widely:

  • Surgery (Prostatectomy); The procedure typically takes several hours with a stay in hospital that may last a few days. Recovery can span weeks.
  • Radiotherapy; Radiation may be delivered daily usually over the course of several weeks.
  • Hormone Therapy; This treatment may be administered over several months to years, depending on the stage and your response to therapy.
  • Chemotherapy; Treatment schedules can vary but chemotherapy is typically given in cycles with intermittent rest periods.
  • Immunotherapy and Targeted Therapy; Treatment plans differ based on the specific drugs used and the individual response.

Recovery and Follow-Up:

  • After active treatment the recovery process begins. The timeline for recovery and side effect management is variable.
  • Follow-up appointments with the clinical team are scheduled to monitor progress, check for recurrence and address any lingering side effects.

Ongoing Monitoring:

  • Prostate cancer survivors typically require ongoing monitoring which may include regular check-ups, PSA testing and imaging studies.
  • The frequency of follow-up appointments depends on the stage and characteristics of the cancer and the treatment received.

It is important to understand that prostate cancer treatment and recovery is a highly individualised process. The timeline can be influenced by factors such as the patient’s response to treatment, the presence of side effects and any potential complications. Throughout the process, communication with the entire healthcare team is essential for addressing concerns and ensuring that the treatment plan remains appropriate for the patient’s condition. Patients should also maintain a healthy lifestyle and emotional support to aid in the recovery process. [back to top]

What support resources are available to me?

In the United Kingdom, there are various prostate cancer support resources and organizations that offer information, guidance and in-person support to individuals affected by prostate cancer. These resources can help patients, caregivers, and family members navigate their prostate cancer journey. Some of the key support resources in the UK include:

  1. Prostate Cancer UK; Prostate Cancer UK is a leading charity dedicated to supporting people affected by prostate cancer. They offer a range of resources, including a helpline, online forums, publications, and information on diagnosis, treatment and living with prostate cancer. They can be found at-  Prostate Cancer UK.
  2. Macmillan Cancer Support; Macmillan provides extensive support to individuals affected by cancer, including those affected by prostate cancer. They offer information on diagnosis, treatment and living with cancer, as well as related services, including financial advice and emotional support. Visit their website for more information. Macmillan Cancer Support.
  3. Movember Foundation: The Movember Foundation is dedicated to addressing men’s health issues including prostate cancer. They fund research and provide support for those affected by the disease. You can find valuable information and resources on their website. Movember Foundation.
  4. Maggie’s Cancer Centres: Maggie’s Centres provide free practical, emotional, and social support to people with cancer and their families. They offer a range of services, including counselling, workshops and support groups. Find a Maggie’s Centre near you on their website: Maggie’s Cancer Centres.
  5. Cancer Research UK: While primarily focused on cancer research, Cancer Research UK offers information and resources about prostate cancer including its causes, symptoms, and treatment options. Visit their website for detailed information: Cancer Research UK – Prostate Cancer.
  6. Local NHS Services: The National Health Service (NHS) provides cancer care services, including specialised cancer centres and hospitals. Your primary health services can connect you with cancer support services.
  7. Local Support Groups: Many local support groups and organisations provide peer support, educational material and social connections for people with prostate cancer. These groups can be found in local communities and may be affiliated with national organisations like Prostate Cancer UK. Information and details of groups can be found at Prostate Prognosis
  8. Online Forums and Communities; Various online forums and communities provide a platform for individuals to connect with others who have experienced or are currently dealing with prostate cancer. These platforms offer a place to ask questions, share experiences and find support from peers and sometimes clinicians.

When seeking support and available resources for prostate cancer, consider reaching out to one or more of these organisations and sources. It is important to connect with healthcare professionals and the numerous support groups and charitable organisations that can provide invaluable information and assistance with your journey. [back to top]

How often will I need follow-up appointments and tests

The frequency of follow-up appointments and assessments for prostate cancer can vary depending on several factors, including the stage and grade of the cancer and the type of treatment you received. Your healthcare team will create a follow-up plan based on your situation. Here is a general guideline for follow-up appointments and ongoing tests:

Immediately After Treatment:

  • In the period immediately following treatment, such as surgery or radiotherapy you may have more frequent follow-up appointments to monitor your recovery and manage any resulting side effects.

First Year After Treatment:

  • Typically, within the first year after treatment you may have follow-up appointments every 3 to 6 months. These appointments will assess your overall health, monitor for treatment side effects and check for any signs of recurrence.

Subsequent Years:

  • In the following years, if there are no signs of recurrence and your health remains stable, follow-up appointments may become less frequent, occurring once a year or less.

Testing and Monitoring:

  • During follow-up appointments, your healthcare provider may perform tests such as PSA (Prostate-Specific Antigen) blood tests and physical examinations to monitor for any changes to your prostate.
  • Imaging tests, such as CT scans or bone scans may be ordered if there are specific concerns or symptoms.

Long-Term Follow-Up:

  • For some individuals, especially those with higher-risk prostate cancer, follow-up appointments may be more frequent and continue for a longer duration.

It is important to follow your healthcare provider’s recommendations for follow-up appointments and tests. These appointments are essential for monitoring your condition, managing potential side effects in addition to addressing any concerns that may arise.

Remember it is important to communicate openly with your healthcare team about any new symptoms or concerns that may arise between scheduled follow-up appointments. Regular follow-ups and monitoring are important for prostate cancer survivability and to ensure the best possible outcomes and quality of life. [back to top]

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