Early (localised) prostate cancer

What is early prostate cancer?

Consultant urologist, Jonathan Aning, talks you through what prostate cancer is, the main types, risk factors, stages and common treatments available to you.

Prostate cancer starts in the cells of the prostate. The prostate is a small gland that is just below the bladder and in front of the rectum (back passage).

Early-stage prostate cancer is when the cancer cells are only inside the prostate. The cancer has not spread through the capsule that surrounds the prostate. It may also be called localised prostate cancer.

Your test results help tell your doctor the stage of the cancer and if it is early prostate cancer. Prostate cancer may be early, locally-advanced or advanced (metastatic).

Prostate cancer is the most common cancer in men in the UK. It is more common over the age of 65. It can happen at a younger age but is uncommon under 50.

If you are a trans woman or are non-binary assigned male at birth, you also need to be aware of prostate cancer.

Related pages

What is cancer?

Booklets and resources

Symptoms of early prostate cancer

Early prostate cancer may not cause any symptoms. Symptoms only happen when the cancer is large enough to press on the tube that carries the urine from the bladder (urethra). Some prostate cancers grow very slowly. Symptoms may not develop for many years.

The prostate can also become enlarged due to a non-cancerous condition called benign prostatic hyperplasia (BPH).

The symptoms of benign (non-cancerous) prostate conditions and prostate cancer are similar. They can include:

needing to pee more often than usual, especially at night
difficulty peeing – for example, a weak flow or having to strain to start peeing
feeling like you have not completely emptied your bladder
an urgent need to pee
blood in urine or semen
rarely, pain when peeing or ejaculating.

If you have any of these symptoms, it is important to have them checked by your doctor. Your GP can do some tests to find out if you need a referral to a specialist doctor.

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Do I have cancer?

Causes of early prostate cancer

Certain things called risk factors may increase the risk of developing prostate cancer. If you are Black, you have a much higher risk of developing prostate cancer. You are also more likely to develop it at a younger age. Having a strong family history of prostate cancer is also a risk factor.

We have more information about the risk factors of prostate cancer.

Diagnosis of early prostate cancer

You usually start by seeing your GP to have your symptoms checked. Your GP usually arranges some tests. The first tests used to diagnose prostate cancer are:

Rectal Examination

The doctor gently inserts a gloved finger (using lubricating gel) into your back passage (rectum). The rectum is close to the prostate gland so your doctor can feel for anything unusual in the prostate. A rectal examination test is quick and it should not be painful. It is also sometimes called Digital Rectal Examination (DRE).
PSA test

The PSA test is a blood test to measure the level of prostate-specific antigen (PSA) in your blood. Prostate cancer often causes a raised level of PSA. But different things such as non-cancerous prostate conditions and getting older can also increase your PSA.

If your PSA level is raised or your rectal examination is unusual your GP refers you to a specialist doctor (urologist). Your GP may test your PSA level again if it is raised but your prostate feels normal.

At the hospital

A specialist doctor or nurse asks about your symptoms and any other medical conditions. They check if you have any risk factors for prostate cancer. The doctor may do another rectal examination and arrange another PSA test. They will talk to you about further tests you may have. These may include:

A multi-parametric MRI scan

You may have this specialised scan to help your doctor decide if you need to have a prostate biopsy. A multi-parametric MRI scan gives a more detailed picture of the prostate gland and surrounding area than a standard MRI scan.
Trans-rectal ultrasound (TRUS) biopsy

You may have a TRUS biopsy if tests show you may have prostate cancer. They use a fine needle to remove samples of prostate tissue to examine for cancer cells. This is done through an ultrasound probe your doctor passes into your back passage. You have an injection of local anaesthetic to numb the area first.
Trans-Perineal (TP) biopsy

You may have a Trans-Perineal biopsy instead of a TRUS biopsy. The doctor takes samples of the prostate gland through the area between the scrotum and the back passage (called the perineum). It can be done under a general anaesthetic or using local anaesthetic to numb the area first.

Further tests after diagnosis

Whether you have any further tests will depend on the risk of the cancer growing quickly. Doctors work out your risk by looking at the PSA level, the stage, and the grade of the cancer.

To help diagnose or stage prostate cancer, you may have staging tests:

an MRI (magnetic resonance imaging) scan
a bone scan
a CT scan
more blood tests.

Booklets and resources

Staging and grading of early prostate cancer

Knowing the stage, grade and risk group of the cancer helps you and your doctor to decide on the best treatment for you.

The stage

The stage of prostate cancer describes its size and how far it has spread, based on your test results. Doctors often use the TNM staging system or a number staging system.

The grade

Your doctor decides the grade by how the prostate cancer cells (from your biopsy) look under the microscope. This tells them how quickly the cancer might grow or spread. Doctors use a combination of 2 systems to grade prostate cancer:

Gleason score - examines the pattern of cells in the prostate tissues and grades them from 1 to 5. The most common and highest grades are added to give your Gleason score
Grade Group - grades the cancer between 1 and 5 based on your Gleason score.

Risk group

Prostate cancer is also divided into risk groups. Your treatment options will depend on the risk group the cancer is in.

Your doctor looks at the stage of the cancer, your PSA level and your Gleason score to work out the risk group. They use a system called the Cambridge Prognostic Group (CPG). It divides prostate cancer risk into 5 different groups.

Treatment for early prostate cancer

A team of specialists meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). There are different treatments. Your treatment will depend on:

your general health
your age
the risk group of the cancer
your preferences.

Your doctor and nurse will talk to you about the different things to think about when making treatment decisions.

Treatment side effects can include, erection difficulties (ED), urinary or bowel problems. They will explain the different benefits and disadvantages of each treatment. You and your doctor can then decide on the best treatment for you. Some early prostate cancers grow very slowly. They may not need treated straightaway or at all.

Your doctor will talk to you about the following options:

Monitoring
Active surveillance
Instead of having treatment to cure the cancer straight away, you have regular tests to see if the cancer is growing. It means you avoid or delay the side effects of treatment.

Watchful waiting (watch and wait)
Your doctor checks you for symptoms and you may sometimes have tests. It may be suitable if you have another condition that makes it difficult to have surgery or radiotherapy. If the cancer is causing symptoms or is growing you can start hormonal therapy.

Find out more about monitoring prostate cancer.
Surgery or radical prostatectomy

The aim of surgery to remove the prostate (prostatectomy) is to remove all the cancer cells. A prostatectomy is a big operation and may not be suitable for everyone.
Radiotherapy

Radiotherapy for prostate cancer uses high energy rays to treat cancer. You usually have external beam radiotherapy (given from outside the body) to the prostate.

Internal radiotherapy called (brachytherapy) is sometimes given on its own as the main treatment or along with external radiotherapy.
Hormonal therapy

Prostate cancer needs the hormone testosterone to grow. Hormonal therapies reduce the amount of testosterone in the body. They are given as tablets or injections. You may have hormonal therapy for a few months before or after radiotherapy.

The following treatments are much less commonly used for early prostate cancer.

HIFU uses ultrasound to deliver heat to the affected area and to destroy the prostate cancer cells.
Cryotherapy uses a cold gas to freeze and destroy the prostate cancer cells.

You may also have some treatments as part of a clinical trial. For example, a type of photodynamic treatment called vascular photodynamic therapy (VDT) is currently being looked at.

We have more information about prostate cancer treatments, including treatment options for early prostate cancer and locally advanced prostate cancer.

Related pages

After early prostate cancer treatment

You will have regular follow-up appointments after treatment for prostate cancer.

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation such as Prostate Cancer UK.

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat online to our specialists online.
Visit our prostate cancer forum to talk with people who have been affected by prostate cancer, share your experience, and ask an expert your questions.

Sex, relationships and fertility

Prostate cancer treatments can affect your sex life. They can reduce your sex drive (libido) and cause difficulties getting an erection. This is called erectile dysfunction or ED. This may be very worrying for you. There are different treatments and support available to improve sexual difficulties.

Talk to your doctor or nurse about sexual difficulties or concerns. They will be used to talking about these issues. You may want to involve a partner in these discussions.

Fertility

Prostate cancer treatments can affect your fertility. If this is a concern for you, talk to your doctor or nurse. You may be able to store sperm before treatment starts.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Small changes to the way you live such as eating well and keeping active can improve your health and well-being and help your body recover.

About our information

References

Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

C. Parker, E. Castro, K. Fizazi, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020, Volume 31, Issue 9, p1119-1134. Available from www.esmo.org/guidelines/genitourinary-cancers/prostate-cancer

National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management (NICE guideline NG131). Last updated December 2021 to include Risk stratification for localised or locally advanced prostate cancer. Available at www.nice.org.uk/guidance/ng131

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Ursula McGovern, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.