Prostate cancer: what are the usual steps from diagnosis to starting treatment?
Serum biomarkers, MRI and fusion-guided biopsy have made the diagnosis and staging of prostate cancer much more accurate; active surveillance is the preferred option for very low-risk patients, and other risk groups can be treated with the aim of cure by robot-assisted radical prostatectomy, radical radiotherapy or both (Hong Kong Cancer Strategy 2019, Annex One, July 2019).
Financial support and welfare: what to do first?
A first step is to ask the treating doctor or a nurse for a referral to a medical social worker; patients and their families can also apply for medical social services directly to the medical social services unit stationed at a public hospital or specialist clinic, and health care staff at the hospital or clinic, other government departments or welfare agencies can refer a case as well (Social Welfare Department, August 2023).
Medical social workers provide counselling on the emotional, family and caregiving problems that illness brings, help patients plan their discharge, and provide financial or material assistance, for example medical fee waivers, applications for fund subsidies, and referrals for patients and their families to apply for social security allowances (Social Welfare Department, May 2023). For the help available, see Cancer financial support in Hong Kong.
Compiled by this site: when you see the doctor, you can also ask when and where the next follow-up or test will be, and which doctor or case manager to contact; the Hospital Authority has cancer case managers who coordinate the diagnosis and treatment process for cancer patients (government paper submitted to the Legislative Council, July 2025). If you are thinking of moving hospitals or seeing another doctor, you can get the referral letter, test reports and images together first; for the documents needed, see Moving from public to private, or private to public.
What are the usual steps for prostate cancer from diagnosis to starting treatment?
Compiled by this site: based on the sources in the table below, the general steps for prostate cancer from first finding a problem to starting treatment are as follows; the order of the steps and the time they take vary from person to person.
The order of tests and treatment for an individual patient is decided by the treating doctor according to the patient's condition.
| Step | What official sources say |
|---|---|
| Finding something abnormal | Early prostate cancer usually has no symptoms, and symptoms such as difficulty passing urine, frequent urination (especially at night) and blood in the urine are similar to those of benign prostatic hyperplasia, and people who have them should seek medical attention as early as possible (Hong Kong Cancer Strategy 2019, Annex One, July 2019); current evidence is insufficient to recommend for or against population-based prostate cancer screening for men without symptoms, and men considering screening should first discuss the benefits and risks with a doctor (Hong Kong Cancer Expert Working Group on Cancer Prevention and Screening, June 2026) |
| Tests and diagnosis | For men with a raised PSA, further assessment with MRI and blood markers can be considered where appropriate, to help decide whether to have a biopsy (Hong Kong Cancer Expert Working Group on Cancer Prevention and Screening, June 2026); the doctor will carry out some or all of the tests for the patient, including digital rectal examination, a PSA blood test, transrectal ultrasound and biopsy (Cancer Online Resource Hub, July 2026) |
| Staging | After diagnosis the doctor may need further tests, including bone X-rays and/or scans, abdominal ultrasound and/or CT, MRI, PET scan and chest X-ray (Cancer Online Resource Hub, July 2026); serum biomarkers, MRI and fusion-guided biopsy have made diagnosis and staging much more accurate (Hong Kong Cancer Strategy 2019, Annex One, July 2019) |
| Starting treatment | Active surveillance is the preferred option for very low-risk patients; other risk groups can be treated with the aim of cure by robot-assisted radical prostatectomy, radical radiotherapy or both; patients whose cancer has spread but who can still live for many years receive various systemic cancer treatments to prolong survival and improve quality of life, and whether to add radiotherapy is decided according to the sites of spread and the patient's physical condition (Hong Kong Cancer Strategy 2019, Annex One, July 2019) |
| Coordination | The Hospital Authority currently has more than 40 cancer case managers, who coordinate and improve the management process for patients with cancers such as breast cancer, colorectal cancer, gynaecological cancers, blood cancers, musculoskeletal tumours and urological cancers (Government paper to the Legislative Council, July 2025) |
After a prostate cancer diagnosis, how is treatment decided?
After diagnosis the treatment is decided by the doctor according to factors such as how fast the tumour is growing and how far it has spread, and the patient's age and physical condition (Cancer Online Resource Hub, July 2026).
The management of prostate cancer keeps changing as medical technology, biomarkers and drugs advance; when the disease cannot be cured or effectively controlled, comprehensive palliative care for the whole family is provided in a timely way, to relieve symptoms and support the family (Hong Kong Cancer Strategy 2019, Annex One, July 2019).
How are Hospital Authority cancer services arranged?
Most Hospital Authority cancer services (for example diagnostic radiology, pathology, endoscopy, surgery, radiotherapy, chemotherapy and palliative care) are provided mainly in regional hospitals or cancer centres (Hong Kong Cancer Strategy 2019, July 2019). The Hospital Authority has multidisciplinary team clinics or meetings for some cancer types; Hospital Authority cancer services will take a patient-centred multidisciplinary team approach, with teams of doctors, nurses, medical social workers, clinical psychologists, radiation therapists, physiotherapists, occupational therapists, dietitians and other professionals caring for the social and psychological needs of patients and their families (Hong Kong Cancer Strategy 2019, July 2019).
Which specialties are involved? How do I look up fees and financial support?
For the specialties related to prostate cancer, see How to choose a prostate cancer doctor; for the difference between Clinical Oncology and Medical Oncology, see What is the difference between Clinical Oncology and Medical Oncology?.
For MRI and PET scan fees, see MRI fees compared and PET-CT fees compared; the patients served by the Hospital Authority's Radi Collaboration programme include prostate cancer patients under Hospital Authority care; when the doctor judges it necessary, the patient is invited to take part, the cost is fully subsidised by the Hospital Authority, and patients do not need to apply themselves (Cancer Online Resource Hub computed tomography page); for public, private and financial support compared, see Cancer treatment costs in Hong Kong.
What can I ask the doctor?
Compiled by this site: examples of questions you can ask: What type of cancer has been diagnosed, and what stage is it? Which tests are needed next, and who will arrange them? Will the treatment plan be discussed by several specialties together? Which doctor or case manager will be my contact? What will it cost, and what financial support is available?
For how a family member can help at appointments, see What to prepare for a first doctor's visit; for the documents needed to transfer between hospitals, see Moving from public to private, or private to public; for a second opinion, see How to prepare for a second opinion.
For a fuller checklist of what to ask your doctor and care team after a diagnosis, see what to ask your cancer doctor.
Frequently asked questions
What tests are done before prostate cancer is diagnosed?
For men with a raised PSA, further assessment with MRI and blood markers can be considered where appropriate, to help decide whether to have a biopsy (Hong Kong Cancer Expert Working Group on Cancer Prevention and Screening, June 2026); the tests listed by the Cancer Online Resource Hub include digital rectal examination, a PSA blood test, transrectal ultrasound and biopsy.
What happens after a raised PSA?
For men with a raised PSA, further assessment with MRI and blood markers (such as the Prostate Health Index, PHI) can be considered where appropriate, to help decide whether a biopsy is needed (Hong Kong Cancer Expert Working Group on Cancer Prevention and Screening, June 2026); whether and how this is done is discussed between the doctor and the patient according to the individual situation.
Does the cancer case manager service cover prostate cancer?
At that time, the Hospital Authority's cancer case manager service covered only breast cancer and colorectal cancer (Hong Kong Cancer Strategy 2019, July 2019); the Hospital Authority currently has more than 40 cancer case managers, who coordinate the management process for patients with cancers such as breast cancer, colorectal cancer, gynaecological cancers, blood cancers, musculoskeletal tumours and urological cancers; urological cancers are on the list, but the paper does not say which cancers they include, and does not name prostate cancer separately (Government paper to the Legislative Council, July 2025); to find out whether an individual patient is followed up by a case manager, ask the hospital providing the treatment.