What to ask after a prostate cancer diagnosis

Short answer: After a prostate cancer diagnosis, the questions that shape treatment are about the Gleason score and grade group, the PSA and stage, whether the cancer is low-, intermediate-, or high-risk, whether active surveillance is a safe option, and the trade-offs between surgery, radiation, and focal therapies on urinary function, sexual function, and cancer control. Full checklist below.

Prostate cancer is one of the few cancers where doing less can be the right answer — many low-risk cancers are safely watched with active surveillance instead of treated. The questions below help make sure that decision is made with your team, not for you.

Questions about the diagnosis itself

• What is my Gleason score, and what grade group does that put me in (1 through 5)?
• What is my PSA now, and what has the trend been over the past few years?
• What is the clinical stage, and did you use MRI to help determine it?
• How many biopsy cores were positive, and how much cancer was in each?
• Is the cancer confined to the prostate, or is there concern it has spread?
• Do I need additional imaging (bone scan, PSMA PET) to complete staging?

Questions about risk category and prognosis

• Is my cancer low-, intermediate- (favorable or unfavorable), or high-risk?
• What is my expected life expectancy given my age and health — and how does that shape whether to treat now or watch?
• Would genetic testing (germline BRCA1/2, Lynch) change my treatment or my family's screening?
• Would a genomic tumor test (Decipher, Oncotype DX, Prolaris) help clarify whether treatment is needed?

Questions about active surveillance

• Am I a candidate for active surveillance?
• What does the monitoring schedule look like — PSA every 3 to 6 months, MRI, repeat biopsy?
• What findings would move me from surveillance to treatment?
• How often do men on active surveillance eventually need treatment?

Questions about treatment options

• What are all the treatment paths being considered — surgery (prostatectomy), external beam radiation, brachytherapy, focal therapy (HIFU, cryotherapy), hormone therapy?
• What are the differences in cancer control between these options for my risk category?
• What are the realistic risks of urinary incontinence and erectile dysfunction with each option?
• If surgery, is nerve-sparing possible? How many prostatectomies does the surgeon do per year?
• If radiation, will hormone therapy (ADT) be added, and for how long?
• Are there clinical trials relevant to this diagnosis?

Questions about timeline and logistics

• How soon do treatment decisions need to be made? (In most cases, weeks, not days.)
• Should I get a second opinion — and would you recommend a specific center?
• What does recovery from each option look like week to week?

Questions about side effects and quality of life

• What are the short-term and long-term effects on urinary control, sexual function, and bowel function?
• If I need hormone therapy, what side effects should I expect (hot flashes, fatigue, muscle loss, mood)?
• What rehabilitation exists — pelvic floor therapy, sexual health programs — before and after treatment?

Questions about support

• Is there a patient navigator or urologic oncology social worker?
• What prostate cancer support organizations do you recommend? (ZERO Prostate Cancer, Prostate Cancer Foundation, Us TOO.)
• Are there support groups for men on active surveillance, or by treatment path?

A note on second opinions

Because treatment recommendations vary a lot between urologists and radiation oncologists, a second opinion — often at an academic center with a multidisciplinary prostate clinic — is standard practice. It rarely delays treatment and often changes the plan.

If your first appointment left you with a report full of words you don't understand, how to read a pathology report you don't understand is a plain-language walkthrough. For the first 72 hours after diagnosis, what to do first after a cancer diagnosis walks through the order that matters most.

Related reading

• Symptoms of prostate cancer — early signs, PSA, and when to see a doctor.
• Just diagnosed with cancer: what to do first — the first 72 hours, in order.
• Questions to ask after any new diagnosis — the full framework.

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This post is for general informational purposes and isn't a substitute for guidance from your care team.