What is locally advanced 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.

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.

Related pages

What is cancer?

Booklets and resources

Symptoms of locally advanced prostate cancer

Prostate cancer 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.

If prostate cancer spreads, it usually goes to the bones. It may cause pain in the bones, such as in the back. This is called advanced prostate cancer.

Related pages

Do I have cancer?

Causes of locally advanced 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 locally advanced prostate cancer

If you have symptoms that may be caused by prostate cancer, you usually begin by seeing your GP or practice nurse. They will ask about your symptoms and your general health. They may also ask you about any family history of cancer.

They may do the following tests:

Digital rectal examination (DRE)

During a digital rectal examination (DRE), the doctor lubricates a gloved finger with gel. Then they gently insert it through the anus and into the rectum to feel the prostate. As the rectum sits behind the prostate, your doctor can feel for any abnormalities. DRE can detect other conditions, such as inflammation of the prostate (prostatitis) and BPH, as well as a possible prostate cancer.

DRE may feel uncomfortable, but it is quick and should not be painful. Tell the doctor or nurse if you feel pain.

If you are worried or feel uncomfortable about having a DRE, tell your GP or urologist. There are other tests for prostate cancer so they may decide not to do a DRE if you feel this way.
PSA test

The PSA test is a blood test. It can be used with other tests to help diagnose prostate cancer.

Prostate-specific antigen (PSA) is a protein made in the prostate. Some PSA leaks into the blood and can be measured in the PSA test.

Prostate cancer often causes a raised level of PSA. But the test is not always reliable. A raised level of PSA does not mean you have prostate cancer.

Naturally, as you get older, the level of PSA in the blood slowly rises. Your doctor can tell you what they think the normal level of PSA should be for you.

Depending on the information you give to your GP and the results of these tests, your GP may refer you a specialist doctor (urologist) at the hospital. Your GP uses national guidelines to help them decide if an urgent referral is needed.

Related pages

At the hospital

At the hospital, you will meet with a urologist or a urology specialist nurse. The urologist may want to do another PSA test or digital rectal examination.

They will ask about your symptoms, your medications and any other medical conditions you have. They will ask questions to find out whether you have any risk factors for prostate cancer. After this, they will talk to you about having further tests. These may include:

Multi-parametric MRI scan (mpMRI)

An MRI scan use magnetic fields to build up a detailed picture of certain areas of the body. A multi-parametric MRI (mpMRI) scan is a specialised type of MRI scan. It gives a more detailed picture of the prostate and surrounding area than a standard MRI scan. Your doctor might recommend you have a mpMRI scan if they think you could have prostate cancer.
Prostate biopsy

If your test results show that you may have cancer, your doctor may advise you to have a biopsy. This involves a doctor removing samples of prostate tissue with a fine needle. A pathologist is a doctor who is an expert in studying cells. They look at the samples under the microscope to check for cancer.

A prostate biopsy is usually done as an outpatient. But sometimes people go into hospital and have the biopsy under a general anaesthetic, which means they are not awake when they have it. Or they may have a spinal anaesthetic, which is an injection of anaesthetic around the spine. This numbs them from the waist down to have the biopsy.

There are 2 different types of prostate biopsy:

Transperineal (TP) biopsy

During a TP biopsy, samples of the prostate are taken through the perineum. This is the area between the scrotum and the back passage (anus). The doctor will do a digital rectal examination before they gently pass a small ultrasound probe into the rectum using lubricating gel. The doctor injects the area with local anaesthetic. They place a special grid called a template on the perineum. The doctor then passes a needle through the grid into the skin of the perineum to take small tissue samples. They can take many small tissue samples from different areas of the prostate.
Transrectal ultrasound scan (TRUS) biopsy

Before a TRUS biopsy, you will change into a hospital gown. The doctor will do a rectal examination before they gently pass a small ultrasound probe into the rectum using lubricating gel. This helps the doctor guide a needle along the probe and into the prostate to take the biopsy. The doctor usually takes 10 to 18 small samples of tissue.

Further tests after diagnosis

Sometimes the tests are also used to diagnose and stage prostate cancer. You may not need all of them. Knowing the stage and grade of the cancer helps you and the MDT decide on the best treatment options.

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

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

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

Related pages

Just been diagnosed?

Booklets and resources

Staging, grading and risk group of locally advanced prostate cancer

The results of your tests help your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.

A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread. Prostate cancer is divided into Grade Groups.

Early and locally advanced prostate cancer is also divided into risk groups. Doctors work out your risk group by looking at different factors:

the PSA level
the stage (the size of the cancer and how far it has spread) – this information comes from the scan result
the grade of the cancer (the Gleason score or Grade group) – this is how quickly it might grow, and the information comes from the biopsy result.

Knowing the stage, grade and risk group helps your doctors plan the best treatment for you.

We have more information about staging, grading and risk groups for prostate cancer.

Treatment for locally advanced prostate cancer

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

Treatment may cure locally advanced prostate cancer or keep it under control for many years. There are different treatments. Your treatment will depend on:

your general health
your age
the Gleason score and cancer grade
the stage of the cancer
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.

The main treatments for locally advanced prostate cancer are:

Radiotherapy

Radiotherapy uses high-energy x-rays to destroy the cancer cells. External beam radiotherapy (given from outside the body) is often the main treatment for locally advanced prostate cancer. You may have some internal radiotherapy called brachytherapy along with it.
Hormonal therapy

Prostate cancer needs the hormone testosterone to grow. Hormonal therapies reduce the amount of testosterone in the body. You may have hormonal therapy as tablets or injections. It may be given for several months or up to 3 years after radiotherapy to make your treatment more effective. Hormonal therapy is sometimes given on its own.
Watchful waiting

During watchful waiting, you see your doctor regularly to check on (monitor) the cancer. If you have symptoms or there are signs the cancer is growing you can have treatment, usually with hormonal therapy.

The following treatments are less commonly used in locally advanced prostate cancer:

Surgery or radical prostatectomy
An operation to remove the prostate (prostatectomy) is not often done in locally advanced prostate cancer. It may not be possible to remove all the cancer cells that have spread. You usually have radiotherapy afterwards.
An operation called a transurethral resection of the prostate (TURP) may be done before radiotherapy to help with problems passing urine.
Chemotherapy
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You may have chemotherapy if there is a higher risk of locally advanced prostate cancer coming back.

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

Find out more about prostate cancer treatments.

Related pages

After locally advanced prostate cancer treatment

You will have regular check-ups during and after your treatment. Follow-up appointments are a good time to talk to your cancer doctor or specialist nurse about any concerns you have. Tell them as soon as possible if you have any problems or notice new symptoms between appointments.

We have more information about follow-up care after treatment.

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

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

Sexual wellbeing

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

Most treatments for prostate cancer are likely to cause infertility. This means you will no longer be able to get someone pregnant naturally.

If fertility is a concern for you, talk to your specialist before treatment. It is usually possible to store sperm before treatment starts, but you may need to pay for this. The sperm may then be used later as part of fertility treatment.

Well-being and recovery

Taking good care of yourself can help speed up your recovery after prostate cancer treatment. Even small lifestyle changes may improve your wellbeing.

Even if you already have a healthy lifestyle, you may choose to make some positive changes after treatment. We have more information on leading a healthy lifestyle after treatment.

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 https://www.esmo.org/guidelines/esmo-clinical-practice-guideline-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.