What is localised prostate cancer?

Localised prostate cancer is cancer that’s contained inside the prostate. You may also hear it called early or organ-confined prostate cancer.

Localised prostate cancer often grows slowly – or might not grow at all – and has a low risk of spreading. So it may never cause you any problems or affect how long you live.Because of this, slow-growing localised prostate cancer might not need to be treated. You might be able to have your cancer monitored with regular check-ups instead.

But some men will have cancer that is fast-growing and has a high risk of spreading. This is more likely to cause problems and needs treatment to stop it spreading outside the prostate.

Watch our animation to find out more about prostate cancer:

If you’re not sure whether your prostate cancer is localised, speak to your doctor or nurse. They can explain your test results and the treatment options available. Or you could call our Specialist Nurses for more information and support.

Find out more about prostate cancer.

Diagram of where the prostate is

How is localised prostate cancer diagnosed?

If you’ve been diagnosed with localised prostate cancer, you will have had some or all of the following tests.

Prostate specific antigen (PSA) test

This measures the amount of PSA in your blood. PSA is a protein produced by normal cells in the prostate and also by prostate cancer cells. Read more about the PSA test.

Digital rectal examination (DRE)

The doctor or nurse feels the prostate through the wall of the back passage (rectum). They feel for hard or irregular areas that might be a sign of cancer. Read more about having a DRE.

Prostate biopsy

Thin needles are used to take small samples of tissue from the prostate. The samples are looked at under a microscope to check for cancer. Read more about having a prostate biopsy.

Magnetic resonance imaging (MRI) scan

This creates a detailed image of your prostate and the surrounding tissues. You might have an MRI scan before a biopsy to help decide whether you need a biopsy. An MRI scan may also be used to see if the cancer has spread. Read more about having a scan.

Other tests

You may also need one or both of the following tests to find out if your cancer has spread outside the prostate.

  • Computerised tomography (CT) scan - this can show whether the cancer has spread outside the prostate, for example to the lymph nodes or nearby bones. Lymph nodes are part of your immune system and are found throughout your body. You probably won’t have a CT scan if you’ve already had an MRI scan.
  • Bone scan - this can show whether any cancer cells have spread to the bones, which is a common place for prostate cancer to spread to.

You might not need these scans if other tests show your cancer is unlikely to have spread. Read more about having a scan.

Some men are diagnosed with prostate cancer after surgery for an enlarged prostate, called a transurethral resection of the prostate (TURP). If you have this operation, the pieces of prostate tissue that are removed are checked for cancer.

What do my test results mean?

Your doctor will look at all your test results to get an idea of how quickly your cancer might grow and whether it has spread. This will help you to discuss which treatments might be suitable for you.

PSA level

It’s normal to have a small amount of PSA in your blood, and the amount rises as you get older. Other things can also affect your PSA level. You may have had a PSA test that showed your PSA was raised, and then had other tests to diagnose your prostate cancer.

After you’ve been diagnosed, you will have regular PSA tests. If you have treatment, this is a useful way to check how well your treatment has worked. If your PSA level falls this usually suggests your treatment is working.

If you decide not to have treatment straight away, you will have regular PSA tests to check if your cancer might be growing.

Gleason grade and Gleason score                

Your doctor may talk about your Gleason grade and Gleason score after your biopsy.

Gleason grade

Prostate cancer cells in your biopsy samples are given a Gleason grade. This tells you how aggressive the cancer is – in other words, how likely it is to grow and spread outside the prostate.

When cancer cells are seen under the microscope, they have different patterns, depending on how quickly they’re likely to grow. The pattern is given a grade from 1 to 5. This is called the Gleason grade. If a grade is given, it will usually be 3 or higher, as grades 1 and 2 are not cancer.

Gleason score

There may be more than one grade of cancer in the biopsy sample. An overall Gleason score is worked out by adding together two Gleason grades.

The first is the most common grade in all the samples. The second is the highest grade of what’s left. When these two grades are added together, the total is called the Gleason score.

Gleason score = the most common grade + the highest other grade in the samples.

For example, if the biopsy samples show that:

  • most of the cancer seen is grade 3 and
  • the highest grade of any other cancer seen is grade 4, then
  • the Gleason score will be 7 (3+4).

A Gleason score of 4+3 shows that the cancer is slightly more aggressive than a score of 3+4, as there is more grade 4 cancer.

If you have prostate cancer, your combined Gleason score will be between 6 (3+3) and 10 (5+5). You might only be told your total Gleason score, and not your Gleason grades.

What does the Gleason score mean?

The higher the Gleason score, the more aggressive the cancer, and the more likely it is to spread.

  • A Gleason score of 6 suggests the cancer is slow-growing.
  • A Gleason score of 7 suggests the cancer may grow at a moderate rate.
  • A Gleason score of 8, 9 or 10 suggests the cancer may grow more quickly

Staging

Staging is a way of recording how far the cancer has spread. The most common method is the TNM (Tumour-Nodes-Metastases) system.

  • The T stage shows how far the cancer has spread in and around the prostate.
  • The N stage shows whether the cancer has spread to the lymph nodes.
  • The M stage shows whether the cancer has spread to other parts of the body.

T stage

The T stage shows how far the cancer has spread in and around the prostate. A DRE is usually used to find out the T stage. You might also have an MRI scan or a CT scan to confirm your T stage.

If your T stage is T1 or T2, you will be diagnosed with localised prostate cancer. T3 and T4 are both locally advanced prostate cancer. If cancer has spread to other parts of the body, it is advanced prostate cancer.

T1 prostate cancer

The cancer can’t be felt or seen on scans, and can only be seen under a microscope.

Image showing T1 cancer is contained inside the prostate.

T2 prostate cancer

The cancer can be felt or seen on scans, but is still contained inside the prostate.

  • T2a - the cancer is in half of one side (lobe) of the prostate, or less.
  • T2b - the cancer is in more than half of one of the lobes, but not in both lobes of the prostate.
  • T2c - the cancer is in both lobes but is still inside the prostate.

 

T2 Prostate Cancer

T3 and T4 prostate cancer

If your T stage is T3, this means your cancer is starting to break through the capsule of the prostate. If your T stage is T4, the cancer has spread to nearby organs, such as the neck of the bladder, back passage, pelvic wall or lymph nodes. T3 and T4 are both locally advanced prostate cancer.

N stage

The N stage shows whether your cancer has spread to the lymph nodes near the prostate. This is a common place for prostate cancer to spread to. An MRI or CT scan is used to find out your N stage.

If you have localised prostate cancer, your cancer is contained inside the prostate and will not have spread to the lymph nodes.

M stage

The M stage shows whether the cancer has spread (metastasised) to other parts of the body, such as the bones. A bone scan is usually used to find out the M stage. But most men with localised prostate cancer won’t need a bone scan because the cancer is contained inside the prostate and will not have spread around the body.

Read more about staging.

Ask your doctor or nurse to explain your test results if you don’t understand them. Or call our Specialist Nurses

Is my cancer likely to spread?

Your doctor may talk to you about the risk of your cancer coming back after treatment. To work out your risk, your doctor will look at your PSA level, your Gleason score and the stage of your cancer. This will help you and your doctor to discuss the best treatments for you.

Low risk

Your cancer may be low risk if:

  • your PSA level is less than 10 ng/ml, and
  • your Gleason score is 6 or less, and
  • the stage of your cancer is T1 to T2a.

Medium risk

Your cancer may be medium risk if:

  • your PSA level is between 10 and 20 ng/ml, or
  • your Gleason score is 7, or
  • the stage of your cancer is T2b.

High risk

Your cancer may be high risk if:

  • your PSA level is higher than 20 ng/ml, or
  • your Gleason score is 8, 9 or 10, or
  • the stage of your cancer is T2c, T3 or T4.

What are my treatment options?

Most treatments for localised prostate cancer aim to get rid of the cancer. But localised prostate cancer often grows slowly and might not need treatment. You may be able to have your cancer monitored with regular check-ups instead.

The treatment options for localised cancer are:

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

Active surveillance

Active surveillance is a way of monitoring localised prostate cancer that’s likely to be slow-growing. The aim is to avoid unnecessary treatment in men whose cancer is unlikely to spread – so you’ll avoid or delay the side effects of treatment.

It’s also sometimes suitable for men with medium risk cancer. If you have high risk prostate cancer, active surveillance won’t be suitable for you.

Active surveillance involves monitoring your cancer with regular tests, including PSA tests and biopsies, rather than treating it straight away. Some hospitals may also recommend MRI scans. The tests aim to find any changes that suggest the cancer is growing. If the tests show your cancer might be growing, you’ll be offered treatment such as surgery, radiotherapy or brachytherapy. The aim of treatment will then be to get rid of the cancer completely.

Read more about active surveillance.

Watchful waiting

Watchful waiting is a different way of monitoring prostate cancer that isn’t causing any symptoms or problems. The aim is to keep an eye on the cancer over the long term. If you choose watchful waiting, you won’t have any treatment unless you get symptoms, so you’ll avoid the side effects of treatment. If you do get symptoms, you’ll be offered hormone therapy to control the cancer and help manage symptoms.

Watchful waiting involves having fewer tests than active surveillance. It’s generally suitable for men with other health problems who may not be fit enough for treatments such as surgery or radiotherapy. It might also be suitable if your prostate cancer isn’t likely to cause any problems during your lifetime or shorten your life.

Read more about watchful waiting.

If you’re offered active surveillance or watchful waiting, ask your doctor to explain which one you’re being offered and why. They are quite different ways of monitoring prostate cancer.

Surgery (radical prostatectomy)

This is an operation to remove the prostate and the cancer inside it. There are several types of surgery:

  • keyhole (laparoscopic) surgery
  • robot-assisted keyhole surgery
  • open surgery.

Read more about surgery.

External beam radiotherapy

This uses high-energy X-ray beams to destroy cancer cells from outside the body.

If your prostate cancer is medium or high risk, you will be offered hormone therapy for up to six months before starting external beam radiotherapy. Delaying external beam radiotherapy won’t cause any problems. The hormone therapy shrinks the prostate and makes the external beam radiotherapy more effective.

You may also continue to have hormone therapy for six months after your radiotherapy. Or you may be offered hormone therapy for up to three years if your cancer is high risk.

If your prostate cancer is medium or high risk, you might also be offered high dose-rate brachytherapy at the same time as external beam radiotherapy.

Read more about external beam radiotherapy.

Brachytherapy

This is a type of internal radiotherapy. There are two types of brachytherapy – permanent seed brachytherapy and high dose-rate (HDR) brachytherapy.

  • Permanent seed brachytherapy, also called low dose-rate brachytherapy, involves implanting tiny radioactive seeds into the prostate. It can be used to treat low or medium risk localised prostate cancer.
  • HDR brachytherapy, sometimes called temporary brachytherapy, involves putting a source of radiation into the prostate for a few minutes at a time. HDR brachytherapy is less common than permanent seed brachytherapy, but may be suitable for men with medium or high risk localised prostate cancer.

External beam radiotherapy can be used together with brachytherapy to give higher doses of radiation to the prostate, as well as the area just outside it. You may also have hormone therapy for several months before starting brachytherapy. This can help to shrink the prostate and make the treatment more effective.

Brachytherapy isn’t available in all hospitals. If your hospital doesn’t offer it, your doctor may be able to refer you to one that does.

Read more about permanent seed brachytherapy and high dose-rate (HDR) brachytherapy.

High intensity focused ultrasound (HIFU)

HIFU uses ultrasound to heat and destroy the cancer cells. It’s newer than some of the other treatments for prostate cancer, so we don’t know as much about how well it works or the risk of side effects in the long term. It’s only available in specialist centres or as part of a clinical trial.

Read more about HIFU.

Cryotherapy

Cryotherapy uses freezing and thawing to destroy the cancer cells. It’s newer than some of the other treatments for prostate cancer, so we don’t know as much about how well it works or the risk of side effects in the long term. It’s only available in specialist centres or as part of a clinical trial.

Read more about cryotherapy.

Clinical trials

A clinical trial is a type of medical research. Clinical trials aim to find new and improved ways of preventing, diagnosing, treating and controlling illnesses.

Read more about clinical trials.

Choosing a treatment

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. Ask your doctor or nurse which ones are suitable for you.

What might I want to think about?

Which treatment you choose may depend on several things, including:

  • how far the cancer has spread (its stage) and how quickly it may be growing
  • your age and general health – for example, if you have any other health problems
  • what each treatment involves
  • the possible side effects of each treatment
  • practical things such as how often you would need to go to hospital
  • how you feel about different treatments – for example some men prefer to have their prostate removed, while others don’t want surgery
  • how the treatment you choose now would affect your treatment options in the future if your cancer comes back or spreads.

There’s no overall best treatment, and each one has its own pros and cons. All treatments have side effects, such as urinary problems, problems getting an erection, and fatigue. The type of side effects you get will depend on the treatment you choose. 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. For example, surgery is usually not an option if you’ve already had radiotherapy. Speak to your doctor or nurse about this when deciding on a treatment.

It can be hard to take everything in, especially when you’ve just been diagnosed. Make sure you have all the information you need, and give yourself time to think about what is right for you. Your doctor or nurse can help you think about the pros and cons.

It can help to write down any questions you want to ask at your next appointment. And to write down or record what’s said to help you remember it. It can also help to take someone to appointments, such as your partner, friend or family member. If you have any questions, call our Specialist Nurses.

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. So 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. There are two ways to monitor localised prostate cancer – active surveillance and watchful waiting. Both approaches aim to monitor the cancer over the long term. You won’t have treatment unless the cancer starts to grow or you get symptoms.

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.

What will happen after my treatment?

You will have regular check-ups during and after your treatment to check how well it is working. You’ll have regular PSA blood tests – ask your doctor or nurse how often you’ll have these. Tell them about any side effects you’re getting. There are usually ways of managing side effects.

Make sure you have the details of someone to contact if you have any questions or concerns between check-ups. This might be your specialist nurse or key worker. You can also speak to our Specialist Nurses.

What is my outlook?

You may be concerned about the future and how a diagnosis of prostate cancer will affect your life and your loved ones. It can be difficult and stressful trying to make a decision about your treatment.

It’s normal to worry about dying if you've just been told you have cancer. But most localised prostate cancer is slow-growing and may not shorten a man’s life. For many men with localised prostate cancer, treatment will get rid of the cancer. So having prostate cancer doesn’t necessarily mean you’ll die from it. For some men, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment.

Many men will want to know how successful their treatment is likely to be. This is sometimes called your outlook or prognosis. No one can tell you exactly what your outlook will be, as it will depend on many things, such as the stage of your prostate cancer and how quickly it might grow, your age, and any other health problems. Speak to your doctor about your own situation.

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.

  • What is my Gleason score?
  • How far has my cancer spread?
  • What treatments are suitable for me? How quickly do I need to make a decision?
  • What are the pros and cons of each treatment, including their possible side effects?
  • How effective is my treatment likely to be?
  • Are all of the treatments available at my local hospital? If not, how could I have them?
  • If I decide to have my cancer monitored, what will this involve?
  • Can I join any clinical trials?
  • After treatment, how often will I have check-ups and what will this involve?
  • If I have any questions or get any new symptoms, who should I contact?

Dealing with prostate cancer

Some men say being diagnosed with prostate cancer changes the way they think and feel about life. If you are dealing with prostate cancer you might feel scared, worried, stressed, helpless or even angry.

At times, lots of men with prostate cancer get these kinds of thoughts and feelings. But there’s no ‘right’ way that you’re supposed to feel and everyone reacts in their own way.

Read about things you can do to help yourself and people who can help.

References

Updated: August 2014 | Due for Review: July 2016

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    • National Institute for Health and Clinical Excellence (Great Britain). Low dose rate brachytherapy for localised prostate cancer. London: National Institute for Health and Clinical Excellence; 2005.
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