Decisions about your treatment

This section is about decisions about treatment for prostate cancer. It is for people who have prostate cancer that hasn’t spread to other parts of your body.

Deciding which treatment you need

Your doctor will talk to you about the treatment they suggest. They will explain its benefits and the possible side effects.

This will depend on:

  • where your cancer is
  • how big it is and whether it has spread (the stage)
  • the type of cancer
  • how abnormal the cells look under a microscope (the grade)
  • your general health and level of fitness

These are all things to think about when making decisions about treatment. 

Treatment overview

You might not have treatment straight away. Instead your doctors monitor your cancer closely. Depending on your situation, they call this:

  • active surveillance
  • watchful waiting

The main treatments are:

  • surgery
  • external radiotherapy
  • internal radiotherapy (brachytherapy)
  • hormone therapy
  • high frequency ultrasound therapy (HIFU) (as part of a clinical trial)
  • cryotherapy (as part of a clinical trial)
  • chemotherapy in combination with other treatments 
  • symptom control treatment

You have one or more of these treatments depending on the stage of your cancer.

Your doctors and nurses will tell you what your options are and help you make the decision about your treatment.

Treatment by risk group of prostate cancer

Your doctor might describe your prostate cancer as:

  • localised
  • locally advanced
  • advanced

They use this to help them decide the best treatment for you. 

Localised prostate cancer

Localised prostate cancer is cancer that is completely inside the prostate gland. It hasn’t spread outside the prostate or to any other parts of the body. Doctors can divide localised prostate cancer into risk groups depending on how likely it is that the cancer will grow quickly or spread.

One of the common ways to divide localised prostate cancer is to put them into 3 risks groups:

  • low risk localised prostate cancer
  • medium risk localised prostate cancer
  • high risk localised prostate cancer 

Low risk localised prostate cancer

The treatments your doctor will offer you are:

  • active surveillance or watchful waiting
  • surgery to remove your prostate (radical prostatectomy)
  • radiotherapy – either internal or external beam

Your doctor will discuss the possible risks and benefits of each treatment with you. 

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

The table below shows that there is very little difference in survival between the treatments. Understanding these and the possible side effects of each treatment can help you and your doctor to make a decision. 

The table below shows how many people survive the different treatments for low risk localised prostate cancer after 10 years.
Treatment for low risk localised cancerPercentage of men who survive after 10 years
Active surveillance98 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 table below shows the risk of some of the side effects after 6 months of treatment for low risk localised prostate cancer
Active surveillanceSurgery to remove the prostateExternal beam radiotherapy
Difficulty controlling your bladder39 out of 100 (39%)71 out of 100 (71%)38 out of 100 (38%)
Difficulty getting an erection29 out of 100 (29%)66 out of 100 (66%)48 out of 100 (48%)
Problems controlling your bowels2 out of 100 (2%)1 out of 100 (1%)5 out of 100 (5%)

The risk of the same side effects after 6 years of treatment is similar between the different treatment groups. 

Medium (intermediate) risk localised prostate cancer

You usually have treatment straight away. You might have:

  • surgery
  • radiotherapy, usually with hormone therapy

You might have active surveillance if you don’t want treatment straight away. This is an option if surgery or radiotherapy would be suitable treatments for you in the future. If they wouldn’t be possible for you, you might have watchful waiting instead.

High risk localised prostate cancer

You might have:

  • surgery
  • external radiotherapy with hormone therapy
  • internal radiotherapy with external radiotherapy and hormone therapy

If you can’t have treatment, your doctor might monitor the cancer with watchful waiting.

Locally advanced prostate cancer

Locally advanced prostate cancer means the cancer has broken through the outer covering of the prostate gland into nearby tissues.

Your doctor might monitor your prostate cancer if you don’t have any symptoms. This is called watchful waiting. You can start treatment if you get symptoms.

Treatment options include:

  • external radiotherapy with hormone therapy
  • hormone therapy on its own
  • surgery 

A small number of men might have surgery to remove the prostate gland. But doctors don't often use it as a treatment for locally advanced cancer.

Advanced prostate cancer

Advanced prostate cancer is cancer that started in the prostate and has spread to other parts of the body, such as the bones. 

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

Deciding about your treatment

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 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. 

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:

Last reviewed: 
05 Feb 2020
  • Prostate cancer: diagnosis and management
    National Institute for Health and Care Excellence, January 2019

  • EAU guidelines on prostate cancer. part 1: screening, diagnosis, and local treatment with curative intent-update 2013
    A Heidenreich and others for the European Association of Urology
    European Urology. 2014 Jan;65(1):124-37

  • GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: An update
    Peter J. Hoskina and others
    Radiotherapy and Oncology, June 2013, Volume 107, Issue 3, Pages 325–332

  • Multi-disciplinary Team (MDT) Guidance for Managing Prostate Cancer 
    British Uro-oncology Group (BUG) and the British Association of Urological Surgeons (BAUS) Section of Oncology, September 2013

  • Cancer: Principles and practice of oncology (10th edition)
    VT De Vita, TS Lawrence and SA Rosenberg
    Lippincott, Williams and Wilkins, 2015   

  • TNM Classification of Malignant Tumours (7th edition)
    International Union Against Cancer   
    L.H. Sobin, M.K. Gospodarowicz, Ch. Wittekind
    John Wiley & Sons, Hoboken, New Jersey, 2009

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