Localised prostate cancer

Doctors may describe prostate cancer as localised, locally advanced and metastatic. 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. 

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.

Prognostic groups for localised prostate cancer

Doctors may divide localised prostate cancer into groups depending on how likely it is that the cancer will grow quickly or spread. In the UK, doctors now divide prostate cancer into 5 risk groups. This is the Cambridge Prognostic Group (CPG). The 5 risk groups are from CPG 1 to CPG 5.

Your group depends on:

• your Grade Group or Gleason score
• the prostate specific antigen (PSA) level
• the size of your cancer. This is the T stage

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

Some doctors may use an older system that divides prostate cancer into 3 risk groups. These are:

• low risk prostate cancer. This is the same similar to CPG 1
• medium or intermediate risk prostate cancer. This is the similar to CPG 2 and CPG 3
• high risk prostate cancer. This is the same as CPG 4 and CPG 5

Treatment

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

• your age and general health
• how you feel about the treatments and side effects

You might not have treatment straight away if it’s unlikely that your cancer will grow or develop for many years. Your doctor monitors your cancer closely and you have treatment if it starts to grow. This is active surveillance. Your doctor may recommend you have active surveillance if your cancer is in the CPG 1, 2 or 3.

If you decide to have treatment, it might include:

• surgery to remove your prostate or
• external radiotherapy

Your doctor usually recommends you have treatment if you are in the CPG 4 or 5. This is for high risk prostate cancer. You usually have surgery to remove the prostate or external radiotherapy.

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 46 seconds long. 

Information about treatment

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