Treatments for localized prostate cancer

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Localized prostate cancer is only in the prostate. Localized prostate cancer is divided into risk groups based on the risk of the cancer coming back (recurring) after treatment. Treatment is based on these risk groups. Lower-risk localized prostate cancer grows very slowly and is unlikely to become life-threatening. Higher-risk localized prostate cancer has a higher chance of growing or spreading.

Choosing a treatment for localized prostate cancer can be complicated, especially if the cancer is lower risk and growing slowly. Prostate cancer treatments can seriously affect your quality of life and cause side effects such as erectile dysfunction (problems getting or keeping an erection) and incontinence (loss of bladder control).

It's important to consider the likelihood that cancer will cause problems before deciding what to do. You may not need to be treated right away. You will also need to consider how side effects of treatment may affect your quality of life. Some people are less concerned about these side effects and are more concerned about getting rid of the cancer.

People in higher-risk groups are usually offered aggressive treatment. Those in lower-risk groups may be offered active surveillance without immediate treatment.

If you are older or have other serious health problems and the cancer is growing slowly, it might be helpful to think of prostate cancer as a chronic disease when you consider your treatment options. If you are younger and otherwise healthy, you may be more willing to accept possible side effects if they give you the best chance of a cure.

It may be helpful to talk over your treatment options with someone you trust. You may also want to talk to other people who have had prostate cancer. It's important to know that each person's experience is different. You may also want to consider getting more than one medical opinion.

Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Very low and low-risk localized prostate cancer

Favourable intermediate-risk localized prostate cancer

Unfavourable intermediate-risk localized prostate cancer

High and very high risk localized prostate cancer

Very low and low-risk localized prostate cancer

Very low and low-risk localized prostate cancer usually grows slowly and often doesn't cause symptoms.

Treatment options for very low and low-risk localized prostate cancer include:

  • active surveillance
  • watchful waiting
  • surgery
  • radiation therapy

Surgery

Surgery is a standard treatment for localized prostate cancer. A radical prostatectomy removes the prostate and some tissue around it. A radical prostatectomy may be offered if you are healthy and are expected to live for at least 10 more years. It is not usually offered if you are older than 75.

If certain adverse features are found during surgery, radiation therapy or hormone therapy or both may be given after surgery. Adverse features include positive surgical margins, cancer involving the seminal vesicles or cancer that has grown through the capsule.

Find out more about surgery for prostate cancer.

Radiation therapy

Radiation therapy is a standard treatment for localized prostate cancer. It uses high-energy rays or particles to destroy cancer cells.

External radiation therapy may be offered if you are over the age of 70 and have a higher risk of complications with surgery.

Brachytherapy may be offered instead of external radiation therapy or surgery. Brachytherapy is a form of internal radiation therapy that uses a radioactive substance (radioactive isotope) placed directly into the tumour or very close to it (called an implant).

Find out more about radiation therapy for prostate cancer.

Favourable intermediate-risk localized prostate cancer

Favourable intermediate-risk localized prostate cancer usually grows slowly and often doesn't cause symptoms.

Treatment options for favourable intermediate-risk localized prostate cancer include:

  • active surveillance
  • watchful waiting
  • surgery
  • radiation therapy

Active surveillance

Active surveillance is a standard treatment for slow-growing localized prostate cancer. Treatments for prostate cancer can cause long-term side effects, so you may not want treatment right away. Active surveillance involves monitoring the cancer with regular tests and exams to check if it is starting to grow or cause symptoms. If the cancer starts to grow or you experience symptoms while under active surveillance, you will be offered treatments.

Find out more about active surveillance for prostate cancer.

Watchful waiting

You may be offered watchful waiting if you are elderly and don't want the side effects that come along with treatment or are unable to have treatment due to other medical conditions. Watchful waiting is less intensive than active surveillance. There are no routine tests and it relies more on changes in symptoms. If you start to have symptoms while under watchful waiting, your doctor may discuss treatment for the symptoms.

Find out more about watchful waiting for prostate cancer.

Radiation therapy

Radiation therapy is a standard treatment for localized prostate cancer. It uses high-energy rays or particles to destroy cancer cells.

External radiation therapy may be offered if you are over the age of 70 and have a higher risk of complications with surgery.

Brachytherapy may be offered instead of external radiation therapy or surgery. Brachytherapy is a form of internal radiation therapy that uses a radioactive substance (radioactive isotope) placed directly into the tumour or very close to it (called an implant). Brachytherapy is also sometimes used to give a boost of radiation along with external radiation therapy.

Find out more about radiation therapy for prostate cancer.

Unfavourable intermediate-risk localized prostate cancer

Unfavourable intermediate-risk localized prostate cancer may grow or spread in a few years.

Treatment options for unfavourable intermediate-risk localized prostate cancer include:

  • surgery
  • radiation therapy with or without hormone therapy
  • watchful waiting

Surgery

Surgery is a standard treatment for localized prostate cancer. A radical prostatectomy removes the prostate and some tissue around it. It may be offered if you are healthy and are expected to live for at least 10 more years. It is not usually offered if you are older than 75. The surgeon may also remove lymph nodes from the pelvis (called a pelvic lymph node dissection) at the same time as a radical prostatectomy.

If certain adverse features are found during surgery, radiation therapy or hormone therapy or both may be given after surgery. Adverse features include positive surgical margins, involvement of seminal vesicles or cancer that has grown through the capsule.

Find out more about surgery for prostate cancer.

Radiation therapy

Radiation therapy is a standard treatment for localized prostate cancer. Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation therapy is often given along with hormone therapy.

External radiation therapy may be offered instead of a radical prostatectomy. It may also be given after a radical prostatectomy (called adjuvant radiation therapy) to reduce the risk that the cancer will come back. It may also be used in combination with brachytherapy.

Brachytherapy may be offered as a boost along with external radiation therapy. It is sometimes used on its own instead of external radiation therapy or surgery. Brachytherapy is a form of radiation therapy that uses a radioactive substance (radioactive isotope) placed directly into the tumour or very close to it (called an implant).

Find out more about radiation therapy for prostate cancer.

Hormone therapy

If you have radiation therapy you may also be given hormone therapy before, during or after radiation therapy. Hormone therapy changes the levels of hormones or blocks certain hormones to slow the growth and spread of cancer cells.

Hormone therapies may be used on their own or combined and include:

  • a luteinizing hormone–releasing hormone (LHRH) agonist
  • an LHRH antagonist
  • an anti-androgen

  • an orchiectomy (surgery to remove the testicles)

Find out more about hormone therapy for prostate cancer.

High and very high risk localized prostate cancer

Treatment options for high or very high risk localized prostate cancer include:

  • radiation therapy and hormone therapy
  • surgery
  • watchful waiting

Radiation therapy

You may be offered radiation therapy for high or very high risk localized prostate cancer. Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation therapy is usually given along with hormone therapy. If you are having treatment to relieve your symptoms but not to cure the cancer, you may be given only radiation therapy or hormone therapy.

External radiation therapy may be offered instead of a radical prostatectomy. It may also be given after a radical prostatectomy (called adjuvant radiation therapy) to reduce the risk that the cancer will come back.

Brachytherapy may be offered along with external beam radiation therapy. Brachytherapy is a form of radiation therapy that uses a radioactive substance (radioactive isotope) placed directly into the tumour or very close to it (called an implant).

Find out more about radiation therapy for prostate cancer.

Hormone therapy

Hormone therapy is often used along with radiation therapy. It may be given before, during or after radiation therapy. Hormone therapy changes the levels of hormones or blocks certain hormones to slow the growth and spread of cancer cells. Hormone therapy is usually given along with radiation therapy. If you are having treatment to relieve your symptoms but not to cure the cancer, you may be given only radiation therapy or hormone therapy.

Hormone therapies may be used on their own or combined and include:

  • a luteinizing hormone–releasing hormone (LHRH) agonist
  • an LHRH antagonist
  • an anti-androgen

  • an orchiectomy (surgery to remove the testicles)

Find out more about hormone therapy for prostate cancer.

Surgery

A radical prostatectomy removes the prostate and some tissue around it. A radical prostatectomy may be offered if you are healthy and are expected to live for at least 10 more years. It is not usually offered if you are older than 75. The surgeon may also remove lymph nodes from the pelvis (called a pelvic lymph node dissection) at the same time as a radical prostatectomy.

If certain adverse features are found during surgery, radiation therapy or hormone therapy or both may be given after surgery. Adverse features include positive surgical margins, involvement of seminal vesicles or cancer that has grown through the capsule.

Find out more about surgery for prostate cancer.

Watchful waiting

You may be offered watchful waiting if you are elderly and don't want the side effects that come along with treatment or are unable to have treatment due to other medical conditions. Watchful waiting is less intensive than active surveillance. There are no routine tests and it relies more on changes in symptoms. If you start to have symptoms while under watchful waiting, your doctor may discuss treatment for the symptoms.

Find out more about watchful waiting for prostate cancer.

Clinical trials

Talk to your doctor about clinical trials open to people with prostate cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

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