Treatment overview

There are a number of different treatments that can be used for locally advanced prostate cancer. Most men will need a combination of treatments. The most commonly used are:

  • External-beam radiotherapy – this uses high-energy x-rays to destroy cancer cells.
  • Hormonal therapy – these can be given by injection or tablet. They can reduce the amount of testosterone in your body. Prostate cancer depends on testosterone to grow.
  • Watchful waiting – you won’t start treatment straight away but will be monitored regularly. If there are signs your cancer has started to progress, you may be offered treatment.

Other, less common treatments include:

  • Brachytherapy – this is internal radiotherapy. It is usually given with external-beam radiotherapy to treat locally advanced prostate cancer.
  • Surgery –surgery to remove your prostate gland is called a radical prostatectomy. It is occasionally used to treat locally advanced prostate cancer.

Your healthcare team will discuss all the options with you and what they think will be best for you in your situation.

Treating locally advanced prostate cancer

The main treatment options for locally advanced prostate cancer include external-beam radiotherapy, hormonal therapy and watchful waiting.

Most men with locally advanced prostate cancer will need a combination of treatments. This is often known as multimodal treatment.

External-beam radiotherapy

This uses high-energy x-rays to destroy the cancer cells.

External-beam radiotherapy is usually given with hormonal therapy. It may also be given after surgery or on its own.

Hormonal therapy

Hormones control the growth and activity of normal cells. In order to grow, prostate cancer depends on the hormone testosterone, which is produced by the testicles. Hormonal therapies reduce the amount of testosterone in the body.

Hormonal therapy is usually given with radiotherapy but it can be given on its own. Giving hormonal therapy plus radiotherapy makes the treatment more effective. Hormonal therapy is usually given before, during and after radiotherapy.

Watchful waiting

This is also when doctors monitor your cancer. You will not start treatment to control your cancer unless it progresses. It’s a way of avoiding treatment for as long as possible.

If you are an older man with no symptoms from your cancer or you have medical problems, you may be advised to have watchful waiting. This is because you may live just as long without having any active treatment. And for some men the side effects of treatment may be worse than the effects of the cancer.

If during watchful waiting your cancer starts to progress or you develop symptoms, such as problems passing urine, you will usually be offered hormonal therapy to help control the cancer.

Less common treatments


Locally advanced prostate cancer can also be treated with brachytherapy (also known as internal radiotherapy). It’s usually given with external-beam radiotherapy. Brachytherapy is only carried out in specialist hospitals.


Occasionally, surgery to remove the prostate gland may be carried out to try to stop the cancer spreading. This is called a radical prostatectomy. It’s not commonly used to treat locally advanced prostate cancer. This is because it may not be possible to remove all the cancer cells that have spread outside the prostate gland.

If you do have surgery, you will usually have other treatments, such as radiotherapy, afterwards. This is to reduce the risk of the cancer coming back. Your doctor will talk to you about this before your surgery.

Sometimes other types of surgery are carried out to relieve symptoms or reduce levels of the male hormone testosterone in the body.

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