What is locally advanced prostate cancer?

Locally advanced prostate cancer is when the cancer has grown through the capsule surrounding the prostate. It may have started to spread into tissue or organs close by.

Your test results help your doctor understand the stage of the cancer and whether it is locally advanced.

This video explains prostate cancer. Consultant urologist Jonathan Aning talks about what it is, how it may affect you, and the treatments that may be available.

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What is cancer?

Booklets and resources

Symptoms of locally advanced prostate cancer

Prostate cancer often grows slowly. Symptoms may not develop for many years. Early prostate cancer may not cause any symptoms.
Symptoms usually happen when the cancer is large enough to press on the tube you pee (pass urine) through. This is called the urethra. The prostate can also become enlarged due to a condition called benign prostatic hyperplasia (BPH). Benign means non-cancerous. BPH can develop as you get older.

The symptoms of benign prostate conditions and prostate cancer are similar. Some people will have both BPH and prostate cancer. If you have any of these symptoms, it is important to have them checked by your GP:

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 your urine
blood in your semen
pain when peeing or ejaculating – this is rare.

Sometimes blood in the urine cannot be seen. It can only be detected by a urine test.

Sometimes prostate cancer can cause other symptoms, such as problems getting or keeping an erection (erectile dysfunction). It can also cause loss of appetite and weight loss.

When prostate cancer spreads, it usually goes to the bones. This may cause pain in the bones, such as in the back.

It is important to tell your GP if you have any of these symptoms.

We have more information about the symptoms of prostate cancer when it has spread to other parts of the body. This is called advanced prostate cancer.

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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.

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.

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

Your treatment will depend on:

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

Your doctor or cancer specialist or nurse will explain the different treatments and their side effects. Treatment side effects can include, erection difficulties (ED), urinary or bowel problems.

Your doctor or cancer specialist nurse will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment.

You can use the online decision aid called Predict. You can also read more and compare treatments on the infopool.

Your cancer team may also give you advice about preparing for your treatment. This is sometimes called prehabilitation. It helps to improve your fitness and diet and to get you ready mentally before treatment.

The main treatments for locally advanced prostate cancer include:

Radiotherapy

Radiotherapy uses high-energy x-rays to treat cancer. It destroys cancer cells in the area where the radiotherapy is given. The aim of radiotherapy for locally advanced prostate cancer is to try to cure the cancer, or to control it for many years. Doctors call this radical radiotherapy.

External beam radiotherapy is the most common way of giving radiotherapy for locally advanced prostate cancer. Sometimes it is given with internal radiotherapy (brachytherapy).
Hormonal therapy

Prostate cancer needs testosterone to grow. Some hormonal therapies for prostate cancer reduce the amount of testosterone naturally produced in the body. Others stop testosterone from reaching the prostate cancer cells.

You may have hormonal therapy with radiotherapy to make treatment more effective. Your doctor may advise having hormonal therapy on its own if you are older or are on watchful waiting
and the cancer starts to change. Or if you do not want other treatments or have health problems that would make it difficult.

Hormonal therapy can slow down or stop the cancer cells growing for many years. But it also has side effects.
Watchful waiting (watch and wait)

In some situations, doctors may ask you to think about not having treatment straight away. Instead, they monitor the cancer. This is called watchful waiting.

The aim of watchful waiting is to control the symptoms of prostate cancer rather than cure it. You can have treatment if there are signs the cancer is growing, or if it is starting to cause symptoms.

If this happens, the doctor will usually recommend hormonal therapy. This will not cure the cancer, but it can often help control it for many years.

Surgery to remove the prostate (radical prostatectomy) is not commonly done to treat locally advanced prostate cancer. Surgery may not be able to remove all the cancer cells that have spread outside the prostate. Sometimes, it may be done to try to prevent the cancer spreading. You may need to have radiotherapy afterwards. This may be months or years later.

Some people may have 1 of the following types of surgery if they are having difficulty passing urine (peeing):

a transurethral resection of the prostate (TURP)
a transurethral vaporisation of the prostate (TUVP).

A TURP or TUVP is not done to treat the cancer. But it can help you pass urine more easily again and improve symptoms.
You may have a TURP or TUVP before radiotherapy. This is because radiotherapy can make passing urine more difficult during and for a while after treatment.

You may need a combination of treatments. You may have some treatments as part of a clinical trial. Find out more about prostate cancer treatments.

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After locally advanced prostate cancer treatment

Follow up after treatment for locally advanced prostate cancer

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.

Sometimes side effects may continue or develop months or years after radiotherapy treatment. These are called late effects. Improved ways of giving radiotherapy are reducing the risk of late effects.

Your radiotherapy team will explain these to you.

We have more information about late effects of pelvic radiotherapy, including late effects on the bladder and the bowel.

Sexual difficulties

Prostate cancer treatments can have a direct effect on your sexual wellbeing. For example, they can cause difficulty with getting or keeping an erection. This is called erectile dysfunction (ED).

With radiotherapy, you may not have ED problems immediately after treatment, but it may develop over years. Hormonal therapy may also lower your ability to get and maintain an erection. Your erections may improve slowly over a few months after stopping hormonal therapy.

Treatment can also affect your ability to have an orgasm or to ejaculate. After having external beam radiotherapy or brachytherapy, you do not usually produce much semen but can still orgasm.

Some treatments can reduce your sex drive (libido). Hormonal therapy can lower your libido.

We have more information about sex life and prostate cancer.

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.

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More information and advice

We know cancer can affect you physically, emotionally and financially. We have information and advice about different ways cancer might impact you, such as help with:

Support after locally advanced prostate cancer

People often have many different feelings during and after locally advanced prostate cancer treatment. If you have finished treatment, you may feel relieved it has ended but worried about what might happen in the future.

It is important to know where to get support or information if you need it. People often need support even some time after prostate cancer treatment. But sometimes it is difficult to know who to ask for help.

To find support:

ask your GP or someone from your cancer team for advice about support in your area
find cancer support services near you
call the Macmillan Support Line free on 0808 808 0000
chat to our cancer information specialists online
visit our Online Community prostate cancer forum to talk to people who have been affected by prostate cancer, share your experience, and ask questions.

The HOPE programme is a free 6 week self-management course designed to help you develop techniques and strategies when living with or after cancer.

Topics include goal setting, fatigue management, and wellbeing. You can sign up for the online HOPE programme. Or to find out more about face to face programmes in your area, email ServiceOpsSupport@macmillan.org.uk

Other organisations who offer information and support

Prostate Cancer UK

Prostate Cancer UK provides information and support to men with prostate cancer and their families. Has office in London, the Midlands, Scotland, Wales and Northern Ireland.
Tackle Prostate Cancer

Tackle Prostate Cancer is an organisation of UK patient-led prostate cancer support groups.

References

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

National Institute for Health and Care Excellence (NICE). Prostate cancer: diagnosis and management. NICE Guideline [NG131]. Published: 09 May 2019. Last updated: 15 December 2021. Available from: www.nice.org.uk/guidance/ng131 [accessed March 2024].

Castro E, Fizazi K, Heidenreich A, Ost P, Parker C, Procopio G, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2020; 31(9): 1119–1134. Available from: www.annalsofoncology.org/article/S0923-7534(20)39898-7/fulltext [accessed March 2024].

Cancer Information Development team

Author

Dr Ursula McGovern

Reviewer

Consultant Medical Oncologist & Honorary Associate Professor

University College Hospitals, London

Date reviewed

Reviewed: 01 October 2025

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Next review: 01 October 2028

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