Sample report — intermediate-risk, choosing between surgery and radiation

This report is educational only. It is not a diagnosis, a treatment plan, or a second opinion, and it is not a replacement for your cancer care team. Do not start, stop, or change any medicine, supplement, or treatment based on this report. Talk with your urologist, oncologist, or primary care clinician before you act on anything here.

If you have any of the following, stop reading and get emergency care now: sudden new weakness or numbness in your legs, loss of bowel or bladder control, inability to urinate at all, uncontrolled bleeding, severe chest pain, or trouble breathing. In the United States, call 911.

This is a sample report shown for illustration. The person, PSA values, and details below are fictional.

You have a new diagnosis of prostate cancer that appears confined to the prostate. Your biopsy was Gleason 3+4=7 (Grade Group 2) and your PSA is 8.4. You are choosing between radical prostatectomy and radiation therapy. Your priorities are long life, sexual function, and staying physically active (you run about four miles most days).

Grade Group 2 with PSA 8.4 places you in the 'favorable intermediate-risk' category in most classification systems, assuming the cancer is confined to the prostate on imaging and only a limited number of biopsy cores are involved. In this category, surgery and radiation produce very similar cancer-control outcomes over 10–15 years in randomized studies. The main differences are in the type, timing, and pattern of side effects, not in survival.

• Radical prostatectomy (typically robot-assisted).
• External beam radiation therapy (EBRT), often with a short course of androgen deprivation therapy (ADT) in intermediate-risk disease.
• Brachytherapy (seed implant), alone or combined with a short course of external beam radiation.
• For carefully selected favorable intermediate-risk patients, active surveillance is sometimes discussed; this requires a detailed conversation with your urologist and often an MRI plus genomic testing.

Long life: 10- and 15-year prostate cancer–specific survival is high and very similar between surgery and radiation for your risk group.

Sexual function: both surgery and radiation reduce erectile function. Surgery tends to cause a sharper drop right after the operation with partial recovery over 12–24 months. Radiation tends to cause a slower decline that appears over 1–2 years. Baseline erectile function, age, and nerve-sparing feasibility strongly affect outcome.

Urinary function: surgery is more likely to cause stress urinary incontinence in the first months, usually improving. Radiation is more likely to cause urinary urgency and frequency during and shortly after treatment.

Bowel function: bowel symptoms (urgency, occasional bleeding) are more common with radiation than surgery.

Staying physically active: recovery from surgery typically limits vigorous running for 4–6 weeks. Radiation does not require a recovery gap but daily treatments last several weeks; fatigue is common.

For intermediate-risk disease treated with radiation, guidelines commonly recommend a short course (about 4–6 months) of androgen deprivation therapy alongside radiation for unfavorable intermediate-risk. For favorable intermediate-risk, ADT is often omitted. ADT has meaningful side effects — hot flashes, fatigue, muscle loss, mood changes, bone density loss — and its inclusion is a specific conversation to have with your radiation oncologist.

For the surgeon: What are your continence and erectile-function outcomes at 6 and 12 months for men my age? What is the likelihood of nerve-sparing on both sides for me? What positive-margin rate do you see? What is your plan if pathology shows adverse features?

For the radiation oncologist: Do you recommend ADT in my case, and if so, for how long? What technique (IMRT, SBRT, brachytherapy boost) do you recommend and why? What are your rates of grade 2+ urinary and bowel side effects at 2 years?

Before committing, most patients benefit from: a multiparametric prostate MRI (if not already done); consideration of a genomic tissue test (Decipher, Prolaris, or Oncotype DX Prostate) which can refine risk; a bone scan or PSMA PET only if clinically indicated; and consultations with both a urologist and a radiation oncologist so you hear each option from its own specialist.

You can search open prostate cancer trials, including trials comparing focal therapy, hypofractionated radiation, and surveillance protocols, at prostatecancertrials.org.

We do not have your MRI results, the number and percent involvement of positive biopsy cores, or any genomic test. These details can move you between 'favorable' and 'unfavorable' intermediate risk and change whether ADT is recommended with radiation.

You are welcome to create another report when you have more information to include, such as MRI results, full biopsy pathology, genomic testing, or specific quotes from your consultations. You can include that new information along with any additional questions you have, and we will produce an updated report.