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Localised prostate cancer

Find out about localised prostate cancer and how it might affect you.

Localised prostate cancer means the cancer is completely contained within the prostate gland. It hasn’t spread anywhere else in the body.

Diagram showing localised prostate cancer

TNM stage

The stage of a cancer tells you how big it is and how far it's spread. It helps your doctor decide which treatment you need. Doctors use a staging system called TNM (Tumour, Node, Metastasis).
  • T describes the size of the tumour (cancer)
  • N describes whether there are any cancer cells in the lymph nodes
  • M describes whether the cancer has spread to a different part of the body
In the TNM staging system, localised prostate cancer is the same as one of the following:
  • T1, N0, M0
  • T2, N0, M0

Risk groups for localised prostate cancer

Doctors divide localised prostate cancer into 3 risk groups depending on how likely it is that the cancer will grow quickly or spread.

Your risk group depends on:

  • your prostate specific antigen (PSA) blood test
  • how the cells look under the microscope (the grade) and the pattern of the cells in the prostate tissue (this is called your Gleason score)
  • the size of your tumour (the T stage)
     

Low risk prostate cancers are unlikely to grow or spread for many years. Your cancer is low risk if you have all of the following:

  • a PSA level less than 10 ng per ml
  • a Gleason score no higher than 6
  • a T stage of between T1 and T2a

Medium (intermediate) risk cancers are unlikely to grow or spread for a few years. Your cancer is medium risk if you have one of the following:

  • a PSA level between 10 and 20 ng/ml
  • a Gleason score of 7
  • a T stage of T2b

High risk cancers might grow or spread within a few years. Localised prostate cancer is high risk if you have one of the following:

  • a PSA level higher than 20 ng/ml
  • a Gleason score between 8 and 10
  • a T stage of T2c

Treatment

Your risk group helps your doctor decide which treatment you need. Treatment also depends on:
  • your age and general health
  • how you feel about the treatments and side effects
  • your type of cancer (the type of cells the cancer started in)

If you don’t have treatment straight away

Your doctors monitor your cancer closely if it is unlikely to grow or develop for many years. If it starts to grow, you have treatment. This is called active surveillance. You have active surveillance if you have either:
  • low risk localised prostate cancer and surgery or radiotherapy are suitable treatments for you in the future
  • or intermediate risk localised prostate cancer if you don’t want treatment straight away
Another way to monitor prostate cancer is called watchful waiting. You have fewer tests than with active surveillance. You have watchful waiting if the doctor aims to control your cancer and:
  • you have no prostate cancer symptoms but you have medical problems which mean surgery or radiotherapy aren’t suitable for you
  • you don’t want active surveillance

If you have treatment

Treatment options might include:
  • surgery to remove the prostate
  • external radiotherapy, with or without hormone therapy
  • internal radiotherapy (brachytherapy),with or without hormone therapy
  • Internal radiotherapy and external radiotherapy
  • cryotherapy, as part of a clinical trial
  • high frequency ultrasound therapy (HIFU), as part of a clinical trial

Radiotherapy and surgery work equally well at curing prostate cancer but they have different side effects. Your doctor can explain these to you.

Last reviewed: 
05 Jul 2016
  • AJCC Cancer Staging Manual (7th Edition)
    S Edge and others.
    Springer. 2011

  • Cancer of the prostate: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    C Parker and others
    Annals of Oncology, 2015. Vol. 26 (suppl 5): v69-v77

  • Guidelines on Prostate Cancer 
    European Association of Urology, 2015

Information and help

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