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Prostate cancer: what happens now

Prostate cancer is the most common cancer in men in Singapore, and many cases are slow-growing.

A diagnosis is a shock, and the first two weeks feel like chaos: appointments, scans, unfamiliar words, and big decisions while you are frightened. There is a normal sequence to this, and you do not have to figure it all out today.

Two things help most early: bring someone to every appointment for a second pair of ears, and ask for a Medical Social Worker early, because they handle the money and admin and unlock most financial help.

What the early appointments are for

  • Confirming the diagnosis: usually a biopsy plus lab tests, to identify exactly what type of cancer it is.
  • Staging scans: imaging such as CT, MRI, PET, or ultrasound to see the size and whether it has spread.
  • Meeting your specialist team: often a surgeon, a medical oncologist, and a radiation oncologist; complex cases are discussed by a multi-disciplinary tumour board.
  • The treatment-plan discussion: the appointment to come prepared for.

Understanding your stage

Stage is how much cancer there is and whether it has spread. A common system is TNM, combined into stages 0 to 4. Some cancers use their own system, shown on each cancer-type page.

Grade is how abnormal the cells look under the microscope, a hint at how fast they may grow.

  • Early or localized (the cancer is contained): treatment is often aimed at cure, and local treatments such as surgery or radiotherapy may be enough.
  • Locally advanced (spread to nearby tissue or lymph nodes): often a combination, for example surgery plus chemotherapy or radiotherapy.
  • Advanced or metastatic (spread to distant parts): the goal is more often to control the cancer and keep you well for as long as possible, usually with drug treatments. Advanced is not the same as untreatable: many advanced cancers are controlled for a long time, and a few such as some lymphomas can still be cured.

Two people with the same cancer can have very different plans, because the stage, the cancer's biology, and your general health all feed into the decision.

Ask your team to explain your specific stage in plain words and what it means for your goal of treatment. Avoid general survival statistics online: they are averages across very different people, often out of date, and not your prognosis.

How your stage is described for Prostate cancer: Prostate cancer is described by more than stage. Your team combines the stage with your PSA and Gleason score or Grade Group into a risk category (often low, intermediate, or high). For low-risk cancer, active surveillance is frequently a recommended option rather than immediate treatment.

Tests you are likely to have

  • PSA blood test, a marker used to detect and monitor prostate cancer.
  • MRI of the prostate, often before a biopsy to target it.
  • Biopsy, which gives a Gleason score or Grade Group (1 to 5), a key measure of how aggressive the cancer is.
  • Staging scans such as a bone scan or PSMA PET if the cancer looks higher risk.

Treatments commonly involved

  • Active surveillance: for many low-risk cancers, closely monitoring with PSA, MRI, and repeat biopsy rather than treating immediately, to avoid side effects.
  • Surgery (radical prostatectomy) to remove the prostate.
  • Radiotherapy, sometimes combined with hormone therapy (ADT) in higher-risk cases.
  • Surgery and radiotherapy can affect urinary control and erectile function, so the trade-offs are worth discussing carefully.

Questions to ask (all cancers)

  • What type of cancer is this, and what is my stage and grade?
  • What is the goal of treatment: to cure, to control, or to relieve symptoms?
  • What are my options, and what do you recommend and why?
  • What are the main side effects, and how long will treatment take?
  • Are any recommended drugs on the Cancer Drug List, and what will it roughly cost?
  • Is a clinical trial an option for me?
  • Who do I contact between appointments, and is there a 24-hour number if I feel unwell during treatment?
  • Can I see a Medical Social Worker about costs and support?

Questions specific to this cancer

  • What are my PSA, Gleason score or Grade Group, and risk category?
  • Is active surveillance a safe option for me, or do you recommend treating now?
  • How do surgery and radiotherapy compare for me, on cure and on side effects (urinary and sexual function)?
  • Will I need hormone therapy, and for how long?

Money and support

The financial and admin load is heavy, and most help is unlocked by people, not websites. The single most useful early action is to ask for a Medical Social Worker. One assessment can open MediFund, hospital and charity cancer funds, subsidised-patient status, and caregiver grants. See the support directory for the full list.

Open the support directory

Support specific to this cancer

  • Continence and erectile-function rehabilitation support after treatment.
  • Singapore Cancer Society support groups.
  • Plus everything in the shared support directory.