Doctors can describe prostate cancer as localised, locally advanced and advanced. Localised prostate cancer is cancer that is completely inside the prostate gland. It hasn’t spread outside of the prostate gland or to any other parts of the body.
Doctors may also describe prostate cancer using the TNM stage and grade.
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
The grade of prostate cancer tells you how much the cancer cells look like normal cells. The Gleason score is the most common system used to grade prostate cancer.
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:
- the size of your tumour (T stage)
- 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)
- your prostate specific antigen (PSA) blood test
Low risk prostate cancer
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 T stage of T1 to T2a
- a Gleason score no higher than 6
- a PSA level less than 10 ng per ml (ng/ml)
Medium (intermediate) risk prostate cancers
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 T stage of T2b
- a Gleason score of 7
- a PSA level between 10 and 20 ng/ml
High risk prostate cancer
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 T stage of T2c
- a Gleason score between 8 and 10
- a PSA level higher than 20 ng/ml
High risk localised prostate cancer is also a locally advanced prostate cancer. This means that even if your cancer is contained within the prostate gland, your doctor might describe it as locally advanced.
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
- 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 don't have any prostate cancer symptoms and you're not suitable for treatments that aim to cure, such as radiotherapy or surgery
- 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
You might also have cryotherapy or 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.
Tools to help you decide
The Predict Prostate tool can help you decide between monitoring and more radical treatment. It is for men whose prostate cancer hasn't spread.
It can't tell you exactly what is going to happen in the future, but it gives you an idea about the differences in survival between the different treatment options. The tool works less well for men with a very high PSA or those with a fast growing or large tumour.
To be able to use the tool you need to know the following about your cancer:
- PSA level
- stage of cancer (T stage)
- grade of cancer
- the Gleason score
Speak to your doctor if you want to find out more about this or if you need help using the tool. There is a video explaining what the tool is about. The video is 1 minute and 48 seconds long.
Information about treatment
Understanding more about the different treatments and the side effects can help you cope.