You Have Prostate Cancer: Ask Your Doctor These 5 Questions

Finding out you have prostate cancer can be an intimidating and overwhelming experience, complete with multiple visits to the doctor and tons of anxiety. Having an open and honest discussion with your doctor and taking plenty of notes are some of the best steps you can take after a prostate cancer diagnosis. Since it's easy to forget what you want to ask once the stress of the diagnosis hits you, consider asking the following five questions:

1. Can I avoid treatment and be monitored under active surveillance?

Your first instinct after diagnosis may be to get rid of the cancer right away. However, not all cancers are aggressive, and they can vary in the rate at which they spread. Some doctors recommend keeping an eye on the cancer in an approach referred to as "active surveillance."

Active surveillance is typically recommended for patients who have a small tumor confined to the prostate, a cancer that is slow-growing or one that is not likely to grow or spread.

Keep in mind that active surveillance is not recommended for all patients with cancer that hasn't spread beyond the prostate. Some patients and their doctors will decide to eliminate a small tumor out of concern it could become more aggressive.

2. How likely is my cancer to advance without treatment?

Doctors take a range of factors into account that can help predict how fast the cancer will grow and spread, including the stage of the cancer, the Gleason score and prostate-specific antigen (PSA) levels.

3. What is my Gleason score and PSA level?

The Gleason score is used to evaluate the grade of prostate cancer cells with a range of 2 (nonaggressive cancer) to 10 (very aggressive cancer). The higher the Gleason score, the more likely the prostate cancer is to spread quickly.

Part of your prostate cancer diagnosis involves blood tests, and your doctor will tell you the level of prostate-specific antigen (PSA) found in your blood. This substance is a protein made by both cancerous and noncancerous tissue in the prostate. The PSA level, which is measured in nanograms per milliliter of blood (ng/ml), is a key factor in determining the risk of the cancer spreading.

The combination of a Gleason score of 6 or below, a PSA level of 10 ng/ml or less and an early tumor stage is considered low risk. These factors indicate that the cancer has a low chance of growing or spreading. On the other hand, a Gleason score of 8 or above, a PSA level greater than 20 ng/ml and an advanced stage indicate a very high risk of the cancer spreading.

4. What are my treatment options and what treatment do you recommend?

Your prostate cancer treatment options will depend on several factors, such as how quickly your prostate cancer is growing, whether it has spread to other parts of the body, and your overall health. Common types of treatment for prostate cancer include surgery and radiation therapy, with chemotherapy and hormone therapy as less-common options. Surgery involves removing the prostate gland and surrounding tissue and lymph nodes, while radiation therapy uses high-energy rays to kill the cancer cells.

Make sure your doctor fully explains all your treatment options. You should speak up if anything is still unclear. Discuss with your doctor the goals of your treatment, the chances of success, and what you can expect when undergoing treatment. You might find that leaning on your partner and bringing them to appointments can be a big help because they might be able to ask the questions that you feel too overwhelmed to voice.

5. What are the side effects of prostate cancer treatment?

Ask your doctor about the potential side effects of your treatment. The prostate gland is close to a number of vital organs, so surgery could affect urinary, bowel and sexual functioning.

Potential side effects may include loss of bladder control, erectile dysfunction, urinary issues, hair loss, vomiting, hot flashes and fatigue. Depending on the type of treatment, lymphedema—swelling that appears in the arms or legs because of a lymphatic system blockage—is possible, too. Some side effects may be short term, while others are long-lasting. You'll also want to ask about sexual side effects, which can include decreased libido and may occur not only during treatment but in your post-cancer life as well.

While a visit to the doctor about your prostate cancer diagnosis can be nerve-wracking, you can ease your anxiety by asking the right questions that give you the information you need. A prostate cancer diagnosis is a serious matter, and you need to have all your concerns addressed, no matter how slight they may seem.