What is locally advanced prostate cancer?

Locally advanced prostate cancer is when the cancer has grown through the capsule that surrounds the prostate. It may have started to spread into tissue or organs close by. The results of your tests help tell your doctor the stage of the cancer and if it is locally advanced.

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Symptoms of locally advanced prostate cancer

If you are worried about prostate cancer, we have more information about the signs and symptoms.

Causes of locally advanced prostate cancer

Prostate cancer is the most common cancer in men in the UK. It is more common over the age 65. Although it can happen at a younger age it is uncommon under 50. People who have a prostate include men, trans women and people assigned male at birth. If you are a trans woman and have had genital gender affirming surgery as part of your transition, you still have a prostate. Trans men do not have a prostate. It is important to talk to your GP or nurse if you are worried about prostate cancer or have symptoms.

Prostate cancer may be early, locally advanced or advanced.

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

Diagnosis of locally advanced prostate cancer

If you have symptoms, you usually begin by seeing your GP. The first tests used to diagnose prostate cancer are:

Your GP may refer you for other tests at the hospital:

  • Trans-rectal ultrasound scan (TRUS) biopsy

    You may have a TRUS biopsy if the rectal examination and PSA tests show there is a possibility of cancer. Samples are taken to check for cancer cells.

  • Template biopsy

    If the TRUS biopsy does not show cancer but your PSA rises afterwards, you may have a template biopsy. You have this under a general anaesthetic.

  • Multi-parametric MRI scan

    You may have a special scan called a multi-parametric MRI scan to decide if you need another biopsy. In some hospitals they may do this scan first to see if a biopsy is necessary in the first place.

  • PCA3 (prostate cancer antigen 3) test

    The PCA3 test is still being researched, but helps doctors decide whether you should have a biopsy.

Most prostate cancers grow very slowly. Even if it takes a couple of weeks to get your results, it is unlikely that the cancer will change during this time.

Waiting for test results can be a difficult time, we have more information that can help.

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:

Staging and grading of locally advanced prostate cancer

The stage of a 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.

A doctor decides the grade by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread. You and your doctors can then talk about the best treatment choices for you.

Treatment for locally advanced prostate cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Treatments may be able to successfully treat the cancer or help keep it under control for many years.

Your doctor will explain the different treatments and their side effects. They will also talk to you about the things you should consider when making treatment decisions.

There are three main types of treatment:

  • Radiotherapy

    Radiotherapy uses high energy rays to destroy cancer cells. It is usually given externally (from outside the body). Or radiotherapy may be given internally (from inside the body). This is known as brachytherapy.

  • Hormonal therapy

    Hormonal therapies reduce the amount of testosterone in the body. This may slow the growth of the cancer or stop it growing for a while.

  • Watchful waiting

    Watchful waiting is when you do not have treatment straightaway. Instead your doctors monitor the cancer. If the cancer starts to grow, your doctor will usually recommend hormonal therapy to control the cancer.

Surgery is not commonly used to treat locally advanced prostate cancer. But occasionally it may be used to try to prevent the cancer spreading.

You may also have some treatments as part of a clinical trial.

Find out more about prostate cancer treatments.

After locally advanced prostate cancer treatment


You have regular follow-up appointments after treatment. Your doctor usually does a PSA test and sometimes a rectal examination.

After treatment, you may be cured of prostate cancer. But for some people, cancer may come back after treatment. If this happens, you may be able to have further treatment.

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

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

Sex, relationships and fertility

Prostate cancer treatments can have a direct effect on your sex life and fertility. They can reduce your sex drive (libido) and cause difficulties getting an erection. This is called erectile dysfunction or ED.

Talk to your doctor or nurse about sexual difficulties or concerns. They will be used to talking about these issues.

Well-being and recovery

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

Making 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

    European Association of Urologists. Guidelines on Prostate Cancer. 2016.

    European Society for Medical Oncology. Cancer of the prostate: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. 2015.

    National Institute for Health and Care Excellence (NICE). Prostate cancer overview. Available from: pathways.nice.org.uk/pathways/prostate-cancer (accessed from March 2017 to November 2017).

    National Institute for Health and Care Excellence (NICE). Surveillance report 2016. Prostate cancer: diagnosis and management (2014). NICE guideline CG175. 2016.

  • 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 Lisa Pickering, 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.

Content under review

Due to the pandemic, there have been delays in us updating this information as quickly as we would have wanted. Our team is working hard to put this right.

The language we use

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

We try to make sure our information is as clear as possible. We use plain English, avoid jargon, explain any medical words, use illustrations to explain text, and make sure important points are highlighted clearly.

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. Our aims are for our information to be as clear and relevant as possible for everyone.

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

Reviewed: 30 June 2018
Reviewed: 30/06/2018
Next review: 30 June 2021
Next review: 30/06/2021

This content is currently being reviewed. New information will be coming soon.