Treatment options for prostate cancer
There are a number of different treatments for prostate cancer. You may have a choice of treatments such as surgery or radiotherapy. Or your doctor might suggest that you have monitoring of your cancer instead of treatment straight away. Your doctor will recommend the best treatment for you.
This page is about treatment for people who have prostate cancer that hasn’t spread to other parts of the body. We also have information about treatment for people who have prostate cancer that has spread to other parts of the body. This is metastatic or advanced prostate cancer.
Deciding what treatment you need
A team of doctors and other professionals recommend the best treatment and care for you. They are called a multidisciplinary team (MDT). The team includes a:
- surgeon who specialises in treating problems of the prostate. This is a urologist
- medical cancer specialist or oncologist
- specialist nurse or clinical nurse specialist (CNS)
- doctor who specialises in understanding scans such as MRI scans. This is a radiologist
- doctor who specialises in looking at cells under the microscope (pathologist)
Your team reviews the scans and tests and recommends the best treatment for you. They will explain its benefits and possible side effects.
The Cambridge Prognostic Groups (CPG)
In the UK, doctors divide prostate cancer into 5 prognostic groups. This is the Cambridge Prognostic Group (CPG). The 5 groups are from CPG 1 to CPG 5. Your CPG depends on:
- the tumour stage. This is from the T stage from the TNM staging
- what the cancer cells look under a microscope. This is the Grade Group or Gleason score
- your PSA blood test level
TNM staging system tells you about how big the cancer is and whether it has spread.
The CPG helps your doctor recommend if you need treatment and the type of treatment you need. Doctors also consider other factors when recommending the best treatment for you:
- your age and general health
- how you feel about the treatment and side effects
If you can’t have treatment because of your age or other health issues, your doctor might monitor the cancer with watchful waiting. They will only recommend treatment if the cancer starts to cause you symptoms.
The 3 risk groups system
Some doctors may still use an older system that divides prostate cancer into 3 risk groups:
- low risk prostate cancer. This is similar to CPG 1
- medium or intermediate risk prostate cancer. This is similar to CPG 2 and 3
- high risk prostate cancer. This is similar to CPG 4 and 5
Treatment by risk group of prostate cancer
Your doctor recommends the best treatment for you depending on your CPG.
Treatment for CPG 1 localised prostate cancer
You might not have treatment straight away. Instead, your doctor recommends monitoring your cancer closely and then discussing treatment if the cancer begins to grow. This is called active surveillance.
If you decide to have treatment, it might include one of the following:
- surgery to remove your prostate
- external radiotherapy
- internal radiotherapy (brachytherapy)
Treatment for CPG 2 localised prostate cancer
You usually have a choice between:
- active surveillance
- surgery to remove your prostate
- external radiotherapy on its own or with hormone therapy
- internal radiotherapy (brachytherapy) with or without external radiotherapy and hormone therapy
Treatment for CPG 3 localised prostate cancer
Your doctor recommends you have one of the following treatments:
- surgery to remove your prostate
- external radiotherapy and hormone therapy
- internal radiotherapy (brachytherapy) with external radiotherapy and hormone therapy
They may also suggest active surveillance if you don’t want to have treatment straightway.
Treatment for CPG 4 and 5 localised and locally advanced prostate cancer
Your doctor usually recommends that you have treatment. You might have:
- surgery to remove your prostate
- external radiotherapy with hormone therapy
- internal radiotherapy (brachytherapy) with external radiotherapy and hormone therapy
- chemotherapy with a drug called docetaxel
- hormone therapy
Choosing the best treatment
It can be difficult to choose the best treatment for you. Your doctor and specialist nurse will explain the different treatment options and help you make a decision. The Predict Prostate tool can also help you decide between monitoring and radical treatment. We have more information about this tool further down this page.
A UK trial showed that there can be very little difference in survival between the treatments especially if you are diagnosed with early prostate cancer.
| Treatment | Percentage of men who survive after 10 years |
|---|---|
| Active surveillance | 98 out of 100 (98%) |
| Surgery to remove your prostate (radical prostatectomy) | 99 out of 100 (99%) |
| Radiotherapy aiming to cure cancer (radical) | 99 out of 100 (99%) |
The same trial also looked at the number of people whose cancer got worse. This is called disease progression. And the number of people whose cancer spread to other parts of the body. Doctors call this distant metastasis.
| Treatment | Percentage of men who had disease progression after 10 years |
|---|---|
| Active surveillance | 21 out of 100 (21%) |
| Surgery to remove your prostate (radical prostatectomy) | 8 out of 100 (8%) |
| Radiotherapy aiming to cure cancer (radical) | 8 out of 100 (8%) |
| Treatment | Percentage of men who had distant metastasis after 10 years |
|---|---|
| Active surveillance | 8 out of 100 (8%) |
| Surgery to remove your prostate (radical prostatectomy) | 3 out of 100 (3%) |
| Radiotherapy aiming to cure cancer (radical) | 3 out of 100 (3%) |
It’s also important to understand the possible side effects of each treatment.
| Active surveillance | Surgery to remove the prostate | External beam radiotherapy | |
|---|---|---|---|
| Difficulty controlling your bladder | 39 out of 100 (39%) | 71 out of 100 (71%) | 38 out of 100 (38%) |
| Difficulty getting an erection | 29 out of 100 (29%) | 66 out of 100 (66%) | 48 out of 100 (48%) |
| Problems controlling your bowels | 2 out of 100 (2%) | 1 out of 100 (1%) | 5 out of 100 (5%) |
Things to consider
If you are asked to choose your treatment you might want to consider the following factors:
- How likely is it that the cancer will cause problems in your lifetime
- How do you feel about living with the cancer in your body and not having treatment
- What are your options and what do they involve
- What are the side effects
- How do you feel about the different treatments
- Are there some side effects that would bother you more than others
- How the treatment side effects might affect your sex life
- How you feel about what is involved practically – for example, spending time in hospital or recovery time
- How quickly do you want to know how well the treatment is working
- What are your treatment options if the cancer comes back in the future
It can be hard to make a complex decision by yourself. Your doctor can help. You could write down questions to ask at your next appointment. You might want to take someone with you to your appointment. There may also be a specialist nurse you can talk things through with.
You might find it helpful to discuss things with your friends and family. Or you can talk to the Cancer Research UK nurses on freephone 0808 800 4040, from 9 to 5, Monday to Friday.
It can help to speak with other men who have made similar decisions. Your specialist might be able to put you in touch with other men with prostate cancer. Or you can talk to men on the Cancer Research UK forum, Cancer chat.
You might also want to get a second opinion from a different doctor. There are different types of doctors who treat prostate cancer. These include surgeons (urologists) and radiotherapy specialists (clinical oncologists). Talking to each type of doctor can help you understand your options fully.
Tools to help you decide
The Predict Prostate tool can help you decide between monitoring and more radical treatment. It is for men who have:
- prostate cancer that hasn't spread
- a Cambridge Prognostic Group (CPG) of 1,2 or 3
The tool 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 Grade Group
-
how much cancer there is - this is based on the number of biopsy samples that contained cancer divided by the number of biopsies taken
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 46 seconds long.
Having treatment as part of a clinical trial
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
What next?
You might want to read about the different types of treatments for prostate cancer. We have information about:
