Questions to Ask Your Urologist About Prostate Cancer

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Medically Approved by Dr Aqua Asif (Feb 18th 2025) and Mr Marc Laniado Consultant Urologist GMC: 3343931

Written by FTC Medical team 

At a Glance

Preparing the right questions before your urology appointment helps you understand your prostate cancer diagnosis, explore all available treatment options, and make confident decisions about your care. At The Focal Therapy Clinic, our consultant urological surgeons have collectively treated over 2,000 patients with focal therapy, achieving 90%+ sexual function preservation and 97% urinary continence (FTC audit, n=265).

• Know your risk factors — age over 50, Black ethnicity, and family history of prostate or breast cancer increase your risk
• Understand PSA testing — a raised PSA does not always indicate cancer but should prompt further investigation such as MRI
• Ask about focal therapy — NICE-approved treatments like HIFU (IPG424) and NanoKnife IRE (IPG768) target only the cancerous area, preserving surrounding tissue
• Compare treatment outcomes — focal therapy offers 90%+ sexual function preservation versus 30-70% with radical prostatectomy
• Plan your follow-up — most men need PSA tests every 3-6 months, with imaging if anything changes

If you are visiting a urologist about prostate cancer for the first time, knowing which questions to ask can help you feel informed and in control of your care. At The Focal Therapy Clinic, our consultant urological surgeons have collectively treated over 2,000 men with prostate cancer using NICE-approved focal therapies — and we know that well-prepared patients make more confident treatment decisions.

This guide covers the key questions to raise with your urologist, from understanding your personal risk and PSA testing through to treatment options like focal therapy and active surveillance.

Preparing for your appointment

Walking into your urology appointment with a clear list of questions reduces anxiety and ensures important topics are covered. At The Focal Therapy Clinic, we encourage every patient to arrive prepared — it helps our consultants understand your situation quickly and recommend the most appropriate next steps.

Why does early detection matter for prostate cancer?

When prostate cancer is found early, you have access to more treatment options — including less invasive approaches like focal therapy that aim to preserve quality of life. In our clinic’s experience treating over 2,000 patients, men diagnosed at an early stage and treated with focal therapy achieve 90%+ sexual function preservation and 97% urinary continence (FTC audit, n=265).

Early detection gives you time to consider your options carefully, discuss them with your family, and choose a treatment path that fits your goals and lifestyle.

What to bring and discuss with your urologist

Arriving with the right information makes your consultation more focused and productive. Bring any previous PSA test results, a list of your current medications, and notes on any early symptoms you have noticed. Writing down your questions beforehand ensures nothing important is missed.

To help guide the conversation, consider bringing:

• Symptom notes — any urinary changes, difficulty starting or stopping, or changes in sexual function
• Medication list — all current medications and supplements, including dosages
• Family cancer history — especially prostate cancer, breast cancer, or known BRCA mutations
• Previous test results — PSA levels, MRI reports, or biopsy results from other providers
• Treatment questions — specific options you want to understand, such as focal therapy, surgery, or active surveillance

Understanding your risk

Your personal risk factors determine when you should begin testing and how closely your prostate health needs monitoring. Understanding these factors helps your urologist create a screening plan tailored to your circumstances — and ensures nothing is missed.

What are my risk factors for prostate cancer?

Prostate cancer risk increases with age, particularly after 50. Men of Black African or Caribbean heritage face significantly higher risk — approximately 1 in 4 Black men in the UK will be diagnosed with prostate cancer during their lifetime (Lloyd et al., BMC Medicine, 2015). A family history of prostate or breast cancer, and inherited BRCA1 or BRCA2 mutations, also increase risk substantially. NICE guideline NG131 recommends that men with these risk factors discuss early screening with their GP or urologist.

Key factors to discuss with your urologist:

• Family cancer history — prostate cancer in a father or brother, or breast cancer in close female relatives
• Ethnicity and age — Black men and all men over 50 are at higher prostate cancer risk
• Genetic factors — known or suspected BRCA1/BRCA2 mutations or Lynch syndrome

 Should I begin testing based on my age or family history?

The UK does not currently have a national prostate cancer screening programme, but that does not mean you should wait for symptoms. The Prostate Cancer UK PSA Consensus (2024) recommends that men over 50 at average risk discuss PSA testing with their GP. For men with higher risk factors — including Black ethnicity or a family history of prostate cancer — testing should be considered from age 45.

At The Focal Therapy Clinic, our consultants regularly see patients who have been proactive about testing and, as a result, have more treatment options available to them. Your GP can arrange an initial PSA test, and our team can provide a specialist second opinion if further investigation is needed.

What should you ask about prostate cancer testing?

Understanding the diagnostic process helps you ask better questions and feel more confident at each stage. NICE guideline NG131 recommends a structured pathway — PSA blood test, followed by multiparametric MRI if indicated, then targeted biopsy if needed. At The Focal Therapy Clinic, our diagnostic pathway follows this evidence-based approach with additional precision through MRI-ultrasound fusion technology.

What does the PSA test measure?

The PSA (prostate-specific antigen) test measures a protein produced by the prostate gland. Elevated PSA levels can indicate cancer, but they can also result from benign causes such as an enlarged prostate (BPH), infection, or recent physical activity. A single PSA reading is rarely enough to make a diagnosis — your urologist will consider it alongside your age, risk factors, and clinical examination to decide whether further investigation is needed.

Are there additional tests like MRI or biopsy?

If your PSA level warrants further investigation, NICE guideline NG131 recommends a multiparametric MRI (mpMRI) before any biopsy. MRI-targeted biopsies detect 12% more clinically significant cancers than standard systematic biopsies (Kasivisvanathan et al., PRECISION trial, NEJM 2018). At The Focal Therapy Clinic, we use advanced MRI imaging fused with real-time ultrasound for the most precise tissue sampling available.

Tests your urologist may recommend:

• Multiparametric MRI — detailed imaging to identify and grade areas of concern within the prostate
• MRI-US fusion biopsy — targeted tissue sampling that combines MRI data with live ultrasound guidance
• Serial PSA monitoring — repeat PSA tests over weeks or months to track trends rather than relying on a single reading

What if my PSA is elevated?

A raised PSA result does not always indicate cancer — common non-cancerous causes include benign prostatic hyperplasia (BPH), prostatitis, urinary tract infections, and even recent vigorous exercise. However, an elevated PSA does warrant further investigation to rule out cancer or catch it early when treatment options are broadest.

At The Focal Therapy Clinic, the next step after an elevated PSA is typically a multiparametric MRI scan. If the MRI identifies areas of concern, our consultants will recommend an MRI-targeted biopsy to confirm or rule out a diagnosis. In our experience, this structured approach — following NICE guideline NG131 — gives patients clarity and confidence about their results.

What treatment options should you discuss?

When prostate cancer is found early, you have a range of treatment options — from monitoring through to minimally invasive focal therapy and more extensive surgery. The right choice depends on the location, grade, and extent of your cancer, as well as your priorities for quality of life. At The Focal Therapy Clinic, our consultants assess every patient individually to recommend the most appropriate path.

What are my options if cancer is found early?

For localised prostate cancer, the main options are active surveillance, focal therapy (HIFU or NanoKnife IRE), radical prostatectomy (surgery), and radiotherapy. Each carries different implications for urinary continence, sexual function, and recovery time. The table below summarises the key differences:

Source: FTC one-year outcome audit (n=265) and published literature. Individual outcomes depend on cancer grade, location, and baseline function.

What is focal therapy and am I a candidate?

Focal therapy targets only the cancerous area of the prostate, preserving surrounding healthy tissue and the structures responsible for urinary continence and sexual function. At The Focal Therapy Clinic, we offer two NICE-approved focal therapy techniques: HIFU (High-Intensity Focused Ultrasound), approved under IPG424, and NanoKnife IRE (Irreversible Electroporation), approved under IPG768.

In our clinic’s experience with over 2,000 procedures, focal therapy achieves 90%+ sexual function preservation and 97% urinary continence (FTC audit, n=265). You are likely to be a candidate if your cancer is localised to one area of the prostate and clearly defined on MRI and biopsy. Our consultants assess suitability through detailed MRI review and multidisciplinary discussion.

How does focal therapy compare to surgery or radiation?

Focal therapy offers significantly better preservation of urinary and sexual function compared to whole-gland treatments. In our audit of 265 patients at The Focal Therapy Clinic, 97% maintained full urinary continence and 90%+ preserved sexual function after focal therapy — compared with published rates of 80-95% continence and 30-70% sexual function preservation after radical prostatectomy.

Focal therapy is a day-case procedure, with 85% of men returning to work within two weeks. Surgery typically requires 1-3 nights in hospital and 4-6 weeks’ recovery. For men with localised prostate cancer, focal therapy offers a middle path between active surveillance and radical treatment — treating the cancer effectively while preserving quality of life.

“If you had completely normal erections before treatment, most men find that their erections return within a few months after focal therapy. By one year, most men find their erections are normal or close to normal.”

What happens after initial test results?

Once your test results have been reviewed, your urologist will recommend next steps — which may include additional imaging, a treatment planning discussion, or referral to a specialist centre. At The Focal Therapy Clinic, patients can meet with one of our consultant urological surgeons to review their results in detail and discuss all available options. If you are uncertain about your diagnosis or recommended treatment plan, a specialist second opinion can provide clarity and confidence.

What is active surveillance and when is it used?

Active surveillance is recommended for lower-risk prostate cancers (typically Gleason 3+3) that are unlikely to grow or spread quickly. It involves regular PSA blood tests, periodic MRI scans, and occasional biopsies to monitor the cancer closely. NICE guideline NG131 supports active surveillance as a safe option for men with low-risk disease — allowing you to avoid or delay treatment and its potential side effects while remaining closely monitored.

If cancer progresses during surveillance, treatment options including focal therapy remain available. In our experience, men who move from active surveillance to focal therapy still achieve excellent outcomes.

How often will I need follow-up?

Follow-up frequency depends on your diagnosis and chosen treatment. Most men on active surveillance or post-treatment monitoring have PSA tests every 3 to 6 months, with MRI imaging typically at 12 months. At The Focal Therapy Clinic, our follow-up protocol includes PSA testing at 3, 6, and 12 months after focal therapy, with a follow-up MRI at 3 months post-procedure to assess treatment effectiveness. Your urologist will adjust this schedule based on your individual results.

What should you do next?

Being well-prepared for your urology appointment puts you in control of your prostate cancer care. The questions in this guide — covering risk factors, PSA testing, imaging, and treatment options — will help you have a focused, productive conversation with your urologist.

If you would like to discuss your diagnosis or explore whether focal therapy is right for you, The Focal Therapy Clinic offers consultations at seven UK locations. Our consultant urological surgeons have collectively treated over 2,000 men with NICE-approved focal therapies including HIFU and NanoKnife IRE. To find out more about consultation fees or to book an appointment, contact our team.

FAQs

What questions should I ask my urologist about prostate cancer risk?

Ask about your specific risk factors: your age, ethnicity, and family history of prostate or breast cancer. Men of Black African or Caribbean heritage and those with BRCA1/BRCA2 mutations face higher risk. Ask whether genetic testing would be helpful and how your risk level should shape your screening schedule.

How can I tell if I need a PSA test or other screening?

If you are over 50 at average risk, or over 45 with higher risk factors (Black ethnicity, family history), the Prostate Cancer UK PSA Consensus (2024) recommends discussing PSA testing with your GP. The UK does not have a national prostate screening programme, so proactive discussion with your doctor is important.

What does it mean if my PSA level is high?

A raised PSA does not always mean cancer. Common non-cancerous causes include benign prostatic hyperplasia, prostatitis, and recent vigorous exercise. However, an elevated PSA usually warrants further investigation — typically a multiparametric MRI scan — to rule out cancer or catch it at an early, treatable stage.

Are there other tests I should ask about besides PSA?

Yes. NICE guideline NG131 recommends multiparametric MRI before any biopsy. If the MRI identifies suspicious areas, an MRI-targeted biopsy provides more accurate tissue sampling than standard systematic biopsy. At The Focal Therapy Clinic, we use MRI-ultrasound fusion technology for the most precise diagnostics available.

Should I be worried if I don’t have symptoms but have a high PSA?

Prostate cancer often develops without symptoms, particularly in its early stages. A high PSA result warrants investigation even if you feel completely well. Early detection — before symptoms appear — is associated with the widest range of treatment options and the best long-term outcomes.

What are the next steps if my results are abnormal?

Your urologist will typically recommend a multiparametric MRI to investigate further. If the MRI identifies areas of concern, a targeted biopsy will confirm whether cancer is present and determine its grade. At The Focal Therapy Clinic, this structured diagnostic pathway follows NICE guideline NG131 and gives you a clear, step-by-step understanding of your diagnosis.

What is focal therapy, and should I ask my urologist about it?

Focal therapy treats only the cancerous area of the prostate, preserving surrounding healthy tissue. NICE-approved techniques include HIFU (IPG424) and NanoKnife IRE (IPG768). It is worth discussing with your urologist if your cancer is localised and you want to minimise the risk of side effects such as incontinence and erectile dysfunction.

What are the pros and cons of focal therapy compared to surgery?

Focal therapy offers significantly better preservation of urinary and sexual function: 97% continence and 90%+ sexual function preservation (FTC audit, n=265), compared with 80-95% continence and 30-70% sexual function after radical prostatectomy. However, focal therapy is best suited to localised cancers — more aggressive or widespread disease may require surgery or radiotherapy.

What should I ask about the side effects of prostate cancer treatments?

Ask your urologist about both short-term and long-term side effects for each option, including urinary incontinence, erectile dysfunction, and fatigue. Ask for specific percentages rather than vague reassurances. At The Focal Therapy Clinic, we share our audited outcome data openly: less than 2% incontinence risk and 90%+ sexual function preservation after focal therapy.

What follow-up care should I ask my urologist about?

Ask about the follow-up schedule, what tests are involved, and what results would trigger a change in your care plan. At The Focal Therapy Clinic, our post-treatment protocol includes PSA testing at 3, 6, and 12 months, with a follow-up MRI at 3 months to assess treatment effectiveness.

How often should I see my urologist if I’m being monitored?

Most men on active surveillance or post-treatment monitoring see their urologist every 3 to 6 months, with PSA blood tests at each visit and MRI imaging typically annually. Your follow-up schedule will be adjusted based on your individual results and how stable your condition remains over time.

What questions should I ask if I want a second opinion?

Ask your current doctor for a full summary of your diagnosis, including MRI reports, biopsy results, and Gleason score. A specialist second opinion can confirm your treatment plan or identify additional options you may not have been offered — including focal therapy, which is not available at all NHS centres.

How can I prepare for my next appointment with my urologist?

Write down any new symptoms, changes in urinary or sexual function, or concerns since your last visit. Bring your latest PSA results, any imaging reports, and a current medication list. Having a written list of questions ensures you cover everything important during your consultation.

References

1. Lloyd T, et al. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008–2010. BMC Medicine. 2015;13:171.
2. Prostate Cancer UK. PSA blood tests for all black men over 45. 2023. Available at: https://prostatecanceruk.org/about-us/news-and-views/2023/01/black-men-over-45-speak-to-their-gp-about-a-psa-blood-test
3. National Cancer Institute. BRCA Gene Changes: Cancer Risk and Genetic Testing Fact Sheet. Available at: https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet
4. Prostate Cancer UK. PSA Consensus 2024. Available at: https://prostatecanceruk.org/for-health-professionals/guidelines/psa-consensus-2024
5. NHS. PSA test. Available at: https://www.nhs.uk/conditions/psa-test/
6. Cancer Research UK. What is the PSA test? Available at: https://www.cancerresearchuk.org/about-cancer/tests-and-scans/prostate-specific-antigen-psa-test
7. Kasivisvanathan V, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;378(19):1767-1777.
8. NHS. Prostate cancer – Should I have a PSA test? Available at: https://www.nhs.uk/conditions/prostate-cancer/should-i-have-psa-test/
9. NICE. Prostate cancer: diagnosis and management. NICE guideline [NG131]. 2019. Available at: https://www.nice.org.uk/guidance/ng131
10. Rokan Z, et al. Focal therapy in prostate cancer: Development, application and outcomes in the United Kingdom. BJUI Compass. 2025.
11. Hamdy FC, et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2023;388(17):1547-1558.
12. Prostate Cancer UK. Follow-up after prostate cancer treatment: What happens next? Available at: https://prostatecanceruk.org/prostate-information-and-support/treatments/follow-up-after-treatment

This blog post is for informational purposes only and should not replace professional medical advice. Always consult with your healthcare provider about your specific situation and treatment options.

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