Localised prostate cancer

Localised prostate cancer is completely inside the prostate gland. It hasn’t spread outside the prostate gland or to any other parts of the body. 

Doctors use the Cambridge Prognostic Group (CPG) to divide prostate cancer into 5 prognostic groups. This tells you how likely it is that your cancer will grow or spread. 

In the TNM staging, localised prostate cancer is the same as T1 or T2. Below is a simplified description of the T1 and T2 stage:

T1 means the cancer is too small to be seen on a scan, or felt during an examination of the prostate.

T2 means the cancer is completely inside the prostate gland. It can usually be seen on a scan, or felt during an examination.

We have a separate page about prostate cancer that has broken through the capsule (covering) of the prostate gland. Some people call this locally advanced prostate cancer. 

Prognostic groups for localised prostate cancer

In the UK, doctors now use the Cambridge Prognostic Group (CPG) for localised prostate cancer. This divides prostate cancer into 5 prognostic groups.

The term prognostic refers to your outlook (prognosis ). So your prognostic group tells you how likely it is that your cancer will grow or spread. And how likely it is that you will die from your cancer. This helps your doctor recommend if you need treatment, and the type of treatment you need.

There are 5 risk groups. These are from CPG 1 to CPG 5.

Your group depends on:

• your Grade Group or Gleason score

• the prostate specific antigen (PSA) level

• how far the cancer has grown in your prostate - this is the T stage

Ask your doctor or specialist nurse if you have any questions about this.

Some doctors may still use an older system. This divides prostate cancer into 3 risk groups. The term risk refers to how likely it is that your cancer will come back after treatment. The risk groups are:

• low risk prostate cancer - doctors consider this to be similar to CPG 1
• medium or intermediate risk prostate cancer - doctors consider this to be similar to CPG 2 and CPG 3
• high risk prostate cancer - doctors consider this to be similar to CPG 4 and CPG 5

If your cancer has spread

When prostate cancer spreads to another part of your body, it is called metastatic prostate cancer. Doctors don't use prognostic groups or risk groups for prostate cancer that has spread. 

Treatment for localised prostate cancer

Treatment for localised prostate cancer depends on your CPG group. It also depends on:

• your age and general health

• how you feel about the treatments and side effects

Your doctor might not recommend treatment straight away. Sometimes your doctor may recommend monitoring your cancer. You only start treatment if the cancer begins to grow. Depending on your situation, they may call this:

• active surveillance
• watchful waiting

If you decide to have treatment, it might include:

• surgery to remove your prostate (prostatectomy)
• external radiotherapy with or without hormone treatment
• internal radiotherapy (brachytherapy )

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. 

Information about treatment

Understanding more about the different treatments and the side effects can help you cope.