Summary of Treatment Options

As detailed in the Risk Category section, you will have been diagnosed with one of three categories of prostate cancer:

Localised (or early-stage) cancer – where the cancer has been found to be enclosed within the prostate. Localised disease has the most options available for a possible cure.

Locally advanced cancer where the cancer has been found to have broken through the capsule and begun to spread outside the prostate. The treatment options are more limited, but the disease may still be potentially curable.

Advanced cancer (sometimes known as metastatic cancer) will have spread to other parts of the body. In this situation it is only possible to treat the cancer with drugs designed to delay the progression of the disease. (For Advanced Cancer treatment see the Advanced and Recurrent Cancer section.)

Where options are available, you may not always be informed of all the possible choices, nor will you necessarily be recommended a particular treatment. It is therefore not always easy to make a decision on which treatment to choose. Some may not be available at your local hospital and you may have to travel to a centre of expertise. Others are not currently approved by NICE and may only be available privately or as part of a clinical trial. Some treatments may be used in combination (e.g. Hormone treatment before surgery, or radiotherapy in order to shrink the prostate).

You should be aware that all treatments have consequences and side effects, which are listed under each treatment in this section. For more information, see the Living with and Surviving Prostate Cancer section. After treatment, regular PSA readings are taken in order to check its success. Any possible cure may not be confirmed for several years.

In the summary below, treatments suitable for Localised prostate cancer are marked (L), Locally advanced (LA) and Advanced (A).


Active Surveillance (L): 
pro-active monitoring of early-stage cancer, with the intention to treat with curative intent if the disease progresses.

Watchful Waiting (L, LA, A): regular check-ups, leading to hormone treatments or palliative care where necessary. The intention is disease control when symptoms arise.

Surgery (L): an operation to remove the whole prostate.

External Beam Radiation Therapy (L, LA): using radiation to destroy the cancer.

Low dose-rate brachytherapy (L): the implantation of radioactive seeds.

High dose-rate brachytherapy (L, LA): the insertion of radioactive rods, removed after treatment.

HIFU (High Intensity Focused Ultrasound) (L): the cancer cells are heated and destroyed by ultrasound.

Cryotherapy (or cryosurgery) (LA): the freezing of cells in the prostate.

Hormone Treatments (Androgen Deprivation Therapy) (L, LA, A): drugs used either when the cancer has spread outside the prostate (LA, A), or prior to curative treatments (L).

Chemotherapy (A): drugs used with hormone therapy or after it has failed.

  Comparison of the three main treatment options:      
  People with low-risk or intermediate-risk Localised Prostate Cancer
  (for whom radical treatment is suitable) – evidence from large UK trial.
Active
Surveillance
Radical
Prostatectomy

Radical
Radiotherapy

  Survival and disease progression at 10 years % % %
  People who had not died of prostate cancer 98 99 99
  Disease progression (e.g. evidence of metastases, or T3 or T4 diagnosis 21 8 8
  Development of distant metastases 8 3 3
       
  Urinary problems      
  Urinary problems at 6 months
39 71 38
  Urinary problems at 6 years
50 69 49
  Moderate to severe urinary problems at 6 months
4 19 6
  Moderate to severe urinary problems at 6 years 8 13 5
       
  Erectile Dysfunction (ED)      
  Moderate to severe Erectile Dysfunction at 6 months
29 66 48
  Moderate to severe Erectile Dysfunction at 6 years 40 50 36
       
  Bowel function problems      
  Problems with faecal incintinence at 6 months
2 1 5
  Problems with faecal incintinence at 6 years
3 2 4
  Moderate to severe impact of bowel habits on quality of live at 6 months
3 3 10
  Moderate to severe impact of bowel habits on quality of live at 6 years 4 3 2

This table has been assembled from information in Table 3 of NICE guideline ‘Prostate cancer: diagnosis and management’ published 9 May 2019. It is intended to be used for health professionals to discuss benefits and harms with patients.