Prostate Cancer Second Opinion After Diagnosis: Understanding Your Options

By Mr Neil Haldar, Consultant Urological Surgeon — Buckinghamshire, Berkshire, Oxfordshire and London.

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Being told you have prostate cancer is frightening. Many men leave their first appointment with a handful of unfamiliar terms — Gleason score, Grade Group, PSA, MRI stage, active surveillance, radiotherapy, surgery — and a sense that they need to make a life-changing decision quickly.

In most cases, a newly diagnosed prostate cancer does not require a same-day treatment decision. There is usually time to understand the diagnosis properly, compare the realistic options and seek a prostate cancer second opinion if you are uncertain. Taking time to make a clear decision is not a delay; it is good medicine.

As a Consultant Urological Surgeon, I see men who have just been diagnosed with prostate cancer and men who want a second opinion on a treatment plan made elsewhere. I offer private consultations across the Thames Valley, including Great Missenden, High Wycombe and Windsor, for men from Buckinghamshire, Berkshire, Oxfordshire, West Hertfordshire and London.

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Why a second opinion can be helpful

A prostate cancer second opinion is not a sign that you distrust your original team. It is a normal and sensible step when the decision has major implications for cancer control, urinary function, erections, ejaculation, continence and quality of life.

A second opinion may help if:

• you have been offered surgery, but have not fully discussed radiotherapy;
• you have been offered radiotherapy but want to understand whether surgery is also suitable;
• you have low-risk cancer and want to know whether active surveillance is safe;
• you have intermediate-risk disease and are unsure whether to treat now or monitor carefully;
• you have high-risk features and want clarity about whether surgery, radiotherapy, hormone therapy or combined treatment is best;
• you want an experienced prostate cancer surgeon to review your MRI, biopsy and PSA results;
• you simply want the diagnosis explained in plain English.

Sometimes a second opinion confirms the plan you have already been given. That can be very reassuring. Other times, it reveals more than one reasonable path, and your priorities should carry real weight in the decision.

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You usually have time to think — but not to ignore it

After a cancer diagnosis, the natural instinct is to act immediately. But prostate cancer is often slower growing than many other cancers, especially when it is localised and lower risk. For many men, the safer approach is to pause, understand the diagnosis, and choose the treatment that best fits the cancer and the person.

That does not mean prostate cancer should be ignored. Some cancers are aggressive and need timely treatment. The key is to understand your risk category and whether your cancer appears to be low-, intermediate-, or high-risk.

You should seek urgent medical advice rather than waiting for a routine appointment if you are unable to pass urine, have severe new bone or back pain, leg weakness or numbness, loss of bladder or bowel control, fever, or if you feel acutely unwell.

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Understanding your prostate cancer diagnosis

Prostate cancer is not one single condition. Some prostate cancers are small and slow-growing. Others are more aggressive and need active treatment. The right recommendation depends on several features.

PSA

PSA is a blood marker produced by the prostate. It helps assess risk, but it does not tell the whole story. A raised PSA can be caused by cancer, but also by benign enlargement, inflammation, infection or recent prostate manipulation.

MRI findings

A prostate MRI helps identify where the suspicious area is, whether the cancer appears confined to the prostate, and whether there are signs of extension beyond the capsule or into nearby structures.

Biopsy result

The biopsy confirms whether cancer is present and provides the Grade Group or Gleason score. This is one of the most important predictors of how the cancer may behave.

Stage

Stage describes whether the cancer appears confined to the prostate, has extended just beyond it, or has spread to lymph nodes or bones.

Risk group

The PSA, MRI, biopsy and stage are considered together to place the cancer into a risk group. This determines whether active surveillance, surgery, radiotherapy, hormone therapy, or another approach is most appropriate.

My role in a consultation is to translate these results into plain language, so you understand not just what the reports say, but what they mean for your choices.

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Treatment options after a prostate cancer diagnosis

There is rarely one automatically correct treatment for every man. The right option depends on the cancer, your age, your general health, your urinary and sexual function, and how you weigh cancer control against potential side effects.

Active surveillance

Active surveillance is often appropriate for low-risk prostate cancer and for some carefully selected intermediate-risk cancers. It means monitoring the cancer closely with PSA tests, MRI scans and repeat biopsies where needed, rather than treating immediately.

This is not “doing nothing”. It is a structured way of avoiding or delaying treatment side effects while keeping the cancer under close review. If the cancer shows signs of progression, treatment can still be offered while a cure remains possible.

Active surveillance may be particularly relevant if your cancer is low volume, low grade and appears confined to the prostate.

Robotic radical prostatectomy

Radical prostatectomy is a surgical procedure to remove the whole prostate and seminal vesicles, usually with the aim of curing localised prostate cancer. In most suitable men, this is now performed robotically, using a keyhole approach.

I perform both open and robotic radical prostatectomy and have carried out more than 1,000 prostatectomies. I also established the da Vinci robotic prostatectomy surgery programme at Buckinghamshire Healthcare NHS Trust and was the first to perform a robotic prostatectomy at The Clementine Churchill Hospital using the new da Vinci dv5 robot.

Surgery may be particularly relevant for men with localised prostate cancer who are fit for an operation and want the cancer removed. It also provides precise final pathology, because the prostate is examined after removal.

The main side effects to discuss carefully are urinary incontinence and erectile dysfunction. The risks vary depending on age, baseline function, cancer position, whether nerve-sparing is possible, and other health factors.

You can read more on my dedicated page: robotic radical prostatectomy.

Open radical prostatectomy

Although robotic radical prostatectomy is now the most common surgical approach for many men with localised prostate cancer, it is not the only way to remove the prostate. In selected cases, an open radical prostatectomy may still be appropriate.

Open radical prostatectomy removes the prostate and seminal vesicles through a lower abdominal incision rather than through small keyhole ports. The aim is the same as robotic surgery: to remove the cancer completely, where cure is possible, while preserving urinary control and sexual function as far as safely achievable.

Most men who are suitable for surgery are considered for a robotic approach first, because it is minimally invasive and usually allows a smaller incision and quicker early recovery. However, some patients may not be ideal candidates for robotic surgery because of previous major abdominal surgery, complex anatomy, anaesthetic concerns, inability to tolerate prolonged head-down positioning, or other individual factors.

In those circumstances, open surgery may remain a valuable option. It may also be appropriate when the safest cancer operation is best achieved through direct open access, depending on the patient’s anatomy and disease characteristics.

The trade-off is that open prostatectomy usually involves a larger incision and may mean more discomfort and a longer early recovery than robotic surgery. However, for carefully selected men, it can still provide excellent cancer control in the hands of experienced surgeons.

The important point is that the choice should not be “robotic surgery at all costs”. It should be the safest and most appropriate cancer treatment for you. If robotic prostatectomy is not suitable, I can discuss whether open radical prostatectomy, radiotherapy, hormone therapy, active surveillance or another approach would be the better option.

Radiotherapy and brachytherapy

Radiotherapy is an excellent curative treatment for many men with prostate cancer. It may involve external beam radiotherapy, stereotactic radiotherapy in selected cases, brachytherapy, or combinations with hormone therapy, depending on risk.

Clinical oncology colleagues deliver radiotherapy. For some men, it is clearly the better option than surgery, particularly where age, medical fitness, cancer features or patient preference point away from an operation.

A good second opinion should not simply ask “can surgery be done?” It should ask whether surgery, radiotherapy or surveillance is the best fit for your individual cancer and priorities.

Hormone therapy and combined treatment

Hormone therapy is often used with radiotherapy for higher-risk or locally advanced prostate cancer. It may also be part of the treatment for cancer that has spread beyond the prostate.

For high-risk disease, the decision is often not surgery versus radiotherapy in isolation, but whether the best plan is surgery, radiotherapy plus hormone therapy, or a combined pathway involving more than one speciality.

Focal therapy and newer approaches

Some men ask about focal therapy, such as HIFU, cryotherapy or other targeted treatments. These aim to treat only the cancerous part of the prostate rather than the whole gland.

Focal therapy may be relevant for selected men with carefully mapped localised disease, but it is not suitable for everyone, and long-term evidence differs from established whole-gland treatments such as surgery and radiotherapy.

If focal therapy is a reasonable option in your case, I will explain it and advise on when specialist assessment may be appropriate.

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How prostate cancer decisions are made

Good prostate cancer care should not be based on one person’s opinion alone. A multidisciplinary team (MDT) usually reviews cancer cases, including urologists, oncologists, radiologists, pathologists, and specialist nurses.

The MDT ensures the diagnosis, imaging, and pathology have been properly reviewed and that treatment options are considered from multiple specialists’ perspectives.

A private second opinion can sit alongside that process. It gives you time to understand the MDT recommendation, ask questions, compare options and decide what feels right for you.

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What I review in a second-opinion consultation

For a prostate cancer second opinion, I will usually review:

• your PSA history;
• MRI report and images where available;
• biopsy report, including Grade Group or Gleason score;
• staging scans if performed;
• clinic letters and MDT recommendations;
• urinary symptoms and baseline continence;
• erectile function and sexual priorities;
• age, general health and medication history;
• family history and personal risk factors;
• your own concerns, preferences and treatment goals.

I will then explain your diagnosis clearly and set out the realistic options. Where surgery is appropriate, I will explain what robotic prostatectomy would involve. Where surveillance, radiotherapy or another treatment is more suitable, I will say so.

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What to bring to your appointment

To get the most from your consultation, please bring or request copies of:

• your PSA blood test results;
• prostate MRI report;
• MRI images if available on disc or electronic link;
• prostate biopsy report;
• any CT, bone scan, PET scan or PSMA PET result;
• clinic letters from your urologist or oncologist;
• current medication list, especially blood thinners;
• a written list of questions.

It is often helpful to bring your partner, a family member, or a close friend. A prostate cancer diagnosis affects more than the prostate, and another person can help you remember what was discussed.

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Questions worth asking before choosing treatment

Before deciding, it is worth asking:

• What is my Grade Group or Gleason score?
• Is the cancer low, intermediate or high risk?
• Does the MRI suggest the cancer is confined to the prostate?
• Is active surveillance safe in my case?
• Am I suitable for nerve-sparing robotic prostatectomy?
• Should I meet a clinical oncologist before deciding?
• What are the likely effects on erections and continence?
• How would each treatment affect my options if the cancer returned?
• How soon do I genuinely need to decide?
• What would you recommend if I were your relative?

A good consultation should make these answers clear.

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Why do men choose to see me?

Men come to see me for a clear explanation, honest options and experienced surgical judgement.

I am a Consultant Urological Surgeon with a specialist interest in prostate cancer and robotic prostate surgery. I have performed more than 1,000 robotic prostatectomies and established the da Vinci robotic urological surgery programme at Buckinghamshire Healthcare NHS Trust.

However, experience is not only about knowing when to operate. It is also about knowing when not to operate. If active surveillance, radiotherapy, hormone therapy or another specialist opinion is more appropriate, I will explain that clearly.

My aim is for you to leave the consultation understanding your diagnosis, your options, and the next sensible step.

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Private prostate cancer consultations across the Thames Valley

I see men with newly diagnosed prostate cancer and men seeking second opinions from across Buckinghamshire, Berkshire, Oxfordshire, West Hertfordshire and London.

My clinic locations include:

• The Chiltern Hospital, Great Missenden – convenient for Amersham, Aylesbury, Chesham, Wendover, Beaconsfield and the Chilterns.
• The Clementine Churchill Hospital, Harrow – convenient for Ealing, Stanmore, Wembley
• The Shelburne Hospital, High Wycombe – convenient for High Wycombe, Marlow, Beaconsfield, Maidenhead, Gerrards Cross and South Buckinghamshire.
• Genesiscare, Windsor – convenient for Windsor, Slough, Maidenhead, Ascot, Berkshire and West London.

Patients also commonly travel from Stoke Poges, Denham, Henley, Thame, Watlington, Hemel Hempstead, Berkhamsted, Rickmansworth, and the surrounding M40, M4, and M25 areas.

If your diagnosis began with a raised PSA and you are still in the investigation stage, you may also wish to read about my rapid access elevated PSA assessment.

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Frequently asked questions

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Arrange a prostate cancer second opinion

If you have just been diagnosed with prostate cancer, or you want an expert second opinion on a treatment plan made elsewhere, I would be glad to help you understand your options clearly and without pressure.

Arrange a private consultation

Mr Neil Haldar is a Consultant Urological Surgeon (GMC 3683914). This page provides general information and is not a substitute for individual medical advice.

Further Reading

NICE prostate cancer diagnosis and management guideline

NHS prostate cancer treatment information

Choosing a prostate cancer treatment – Prostate Cancer UK