Understanding Your Prostate Cancer Diagnosis

Understanding your condition

Prostate cancer is the most common cancer in men. A diagnosis can feel frightening, but it is important to know that the majority of prostate cancers grow slowly and are highly treatable, especially when detected early. The prostate is a small walnut-sized gland that sits below the bladder and produces fluid that forms part of semen.

Prostate cancer is graded using the Gleason score (or Grade Group), which describes how aggressive the cancer cells look under the microscope:

• Grade Group 1 (Gleason 6): Low-grade, typically slow-growing.
• Grade Group 2–3 (Gleason 7): Intermediate-grade; a balanced assessment of treatment versus monitoring is needed.
• Grade Groups 4–5 (Gleason 8–10): Higher-grade; more active treatment is usually recommended.

The stage of the cancer — whether it is confined to the prostate or has spread — is equally important and is determined by MRI, bone scan, or PSMA-PET imaging where appropriate.

What this means for you

Not all prostate cancers require immediate treatment. The right approach depends on your grade group, stage, PSA level, overall health, age, and personal preferences. Options include:

• Active surveillance: For low-risk cancers, close monitoring (PSA, MRI, repeat biopsy) avoids or defers treatment and its side effects without compromising safety.
• Radical prostatectomy: Surgical removal of the prostate, performed robotically or as open surgery.
• Radiotherapy: External beam radiotherapy or brachytherapy (radioactive seed implants), often combined with hormone therapy.
• Hormone therapy (androgen deprivation therapy, ADT): Reduces testosterone to slow cancer growth; used alone or with other treatments.
• Focal therapy: Targeted treatment of the cancer focus within the prostate (e.g. high-intensity focused ultrasound, HIFU), suitable in selected cases.

Dr Hadjipavlou will review your case at a multidisciplinary team (MDT) meeting with oncology, radiology, and pathology colleagues before discussing the full range of options with you.

Monitoring and follow-up

Whatever treatment pathway is chosen, regular follow-up is essential:

• PSA monitoring: Blood PSA levels are measured regularly — typically every 3–6 months initially — to track your response to treatment or confirm stability during surveillance.
• Imaging: Repeat MRI or other scans may be arranged at defined intervals.
• Side effect management: Dr Hadjipavlou’s team will monitor and help manage any treatment-related effects on urinary function, sexual function, or bowel habits, and refer to specialist support services where needed.
• Bone health: If hormone therapy is used long-term, bone density monitoring and protective medication (e.g. bisphosphonates, denosumab) may be recommended.

Questions to ask your doctor

• What is my Grade Group and stage, and what do they mean for my prognosis?
• Has my case been discussed at the multidisciplinary team meeting?
• What are the realistic treatment options for my type and stage of cancer?
• What are the risks and side effects of each treatment?
• If I choose active surveillance, what exactly will be monitored, and what would trigger a move to active treatment?
• How will treatment affect my urinary control and sexual function?
• Are there clinical trials I might be eligible for?
• Where can I get support — psychological, practical, and nutritional?