Choosing a treatment

What affects my treatment options?

Your treatment options will depend on whether your cancer is contained within the prostate gland (localised), has spread just outside of the prostate (locally advanced) or had spread to other parts of the body (advanced).

You may have a choice of treatments. Your doctor or specialist nurse will explain all your treatment options, and help you to choose the right treatment for you.

Your treatment options and which treatment you choose may depend on several things, including:

• how far your cancer has spread (its stage)
• how quickly your cancer may be growing
• the advantages and disadvantages of each treatment
• what each treatment involves
• the possible side effects of each treatment
• practical things, such as how often you would need to go to hospital, or how far away your nearest hospital is
• your own thoughts about different treatments
• how the treatment you choose now could affect your treatment options later if your cancer comes back or spreads
• your general health
• how long you’re expected to live for.

The first treatment you have may affect which treatments you can have in the future, if you need further treatment. Speak to your doctor or nurse about this.

It can help to write down any questions you want to ask at your next appointment. And to take someone to appointments, such as your partner, friend or family member.

It can also help to write down or record what’s said to help you remember it. Talk to your doctor or nurse first to make sure they are happy with you recording the appointment, as not everyone is confortable with being recorded.

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Localised prostate cancer

Localised prostate cancer is cancer that’s inside the prostate and hasn’t spread to other parts of the body.

What are my treatment options?

Localised prostate cancer often grows slowly – or doesn’t grow at all – and might not need treatment. You may be able to have your cancer monitored with regular check-ups instead. If you decide to have treatment, it will usually aim to get rid of the cancer.

The two ways of monitoring localised prostate cancer are:

• active surveillance
• watchful waiting

The main treatments for localised prostate cancer are:

• surgery (radical prostatectomy)
• external beam radiotherapy
• brachytherapy.

You might also be offered high-intensity focused ultrasound (HIFU) or cryotherapy, but they are less common.

Some of the treatments might not be suitable for you, so ask your doctor or nurse about your own treatment options.

Do I need treatment?

This may seem like an odd question, but many localised prostate cancers grow too slowly to cause any problems or affect how long you live. Many men with localised prostate cancer will never need treatment.

If your test results show your cancer is unlikely to spread outside the prostate, you may decide to have your cancer monitored. This means you won’t have treatment unless the cancer starts to grow or you get symptoms. Instead, you will have regular check-ups, including PSA tests, to check if your cancer might be growing.

If you’re thinking about going on active surveillance or watchful waiting, make sure you have all the information you need before you decide. Monitoring isn’t right for everyone. Some men are happy to avoid treatment, but others may worry about not treating their cancer. Speak to your doctor or nurse about your own situation, or speak to our Specialist Nurses.

Which treatment is the best?

There’s no overall best treatment for localised prostate cancer, and each one has its own advantages and disadvantages. All treatments can have side effects. The type of side effects you get will depend on the treatment you choose, and on the experience and skill of the person treating you. So ask your surgeon, oncologist or radiographer about the results of the treatments they have done and the rates of side effects. Treatments will affect each man differently. You might not get all of the possible side effects, but it’s important to think about how you would cope with them when choosing a treatment.

The first treatment you have may affect which other treatments you can have in the future, if you need further treatment. Read about which treatments might be available if your cancer comes back.

Locally advanced prostate cancer

Locally advanced prostate cancer is cancer that has started to break out of the prostate, or has spread to the area just outside the prostate.

What are my treatment options?

Treatments for locally advanced prostate cancer will aim to get rid of the cancer, or to keep it under control, depending on how far the cancer has spread.

The treatment options for locally advanced prostate cancer are:

• external beam radiotherapy with hormone therapy (and sometimes with high dose-rate brachytherapy or permanent seed brachytherapy)
• hormone therapy alone, sometimes with chemotherapy
• surgery (radical prostatectomy)
• watchful waiting

Choosing a treatment

Depending on how far your cancer has spread, you may have a choice of treatments. If so, your doctor or nurse will talk you through your treatment options and help you choose the right treatment for you. You might not be able to have all of the treatments listed above.

Advanced prostate cancer

Advanced prostate cancer is cancer that has spread from the prostate to other parts of the body. You might hear it described as metastatic prostate cancer, secondary prostate cancer, secondaries, metastases or mets.

If you have advanced prostate cancer, treatment won’t cure your cancer. But it can help keep it under control and manage any symptoms.

What are my treatment options?

If you’ve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:

• hormone therapy 
• chemotherapy with hormone therapy
• clinical trials.

Research has found having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer live longer. But radiotherapy isn't suitable for all men with advanced prostate cancer. Read more about radiotherapy for advanced prostate cancer. 

If you don’t have any symptoms and want to avoid or delay treatment and its side effects, you might be able to have your cancer monitored instead. This is known as watchful waiting. It isn’t usually recommended for men with advanced prostate cancer. This is because watchful waiting won’t control the cancer and it won’t stop the cancer from growing or spreading. Your doctor can help you think about the advantages and disadvantages of watchful waiting.

What happens if my cancer starts to grow again?

Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again.

You will usually stay on your first type of hormone therapy. This is because the hormone therapy will still help to keep the amount of testosterone in your body low. But there are other treatments that you can have alongside your usual treatment, to help control the cancer and manage any symptoms.

Your treatment options might include:

• more hormone therapy
• more chemotherapy
• radium-223
• olaparib
• clinical trials

Treatments to help manage symptoms

Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms – there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms. Read more about symptoms and what treatments are available.

Questions to ask your doctor or nurse

You may find it helpful to keep a note of any questions you have to take to your next appointment. If you’re choosing a treatment, you might find it helpful to ask your doctor or nurse some of these questions.

• What treatments are suitable for me?
• How quickly do I need to make a decision?
• What are the advantages and disadvantages of each treatment? What are their side effects?
• How effective is my treatment likely to be?
• Can I see the results of treatments you’ve carried out?
• Is the aim to keep my prostate cancer under control, or to get rid of it completely?
• If the aim of my treatment is to get rid of the cancer, what is the risk of my cancer coming back after treatment?
• If the aim of my treatment is to keep the cancer under control, how long might it keep it under control for?
• What treatments and support are available to help manage side effects?
• Are all of the treatments available at my local hospital? If not, how could I have them?
• After treatment, how often will I have check-ups and what will this involve? How will we know if my cancer starts to grow again?
• If my treatment doesn’t work, what other treatments are available?
• Can I join any clinical trials?
• If I have any questions or get any new symptoms, who should I contact?

References

Updated: September 2023 | To be reviewed: September 2026