Treatments for locally advanced prostate cancer

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The following are treatment options for locally advanced prostate cancer. Locally advanced prostate cancer has spread outside of the prostate but hasn't spread to lymph nodes or distant parts of the body. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Treatment options for locally advanced prostate cancer include:

  • radiation therapy with hormone therapy
  • surgery and radiation therapy, with or without hormone therapy
  • hormone therapy alone
  • watchful waiting

Radiation therapy

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is often used to treat locally advanced prostate cancer. It is usually given together with hormone therapy.

External radiation therapy is the main treatment for locally advanced prostate cancer. It may also be given after a radical prostatectomy (called adjuvant radiation therapy) to reduce the risk that the cancer will come back (recur).

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). It is sometimes given in combination with external radiation therapy.

Find out more about radiation therapy for prostate cancer.


You may be offered one of the following types of surgery for locally advanced prostate cancer.

Radical prostatectomy removes the prostate and some tissues around it. The surgeon may also remove lymph nodes from the pelvis (called a pelvic lymph node dissection) at the same time as a radical prostatectomy. Radiation therapy or hormone therapy or both are sometimes given after a radical prostatectomy.

Transurethral resection of the prostate (TURP) removes part of the prostate through the urethra. TURP may be used to:

  • relieve urinary (peeing) problems caused by an enlarged prostate pressing on the urethra
  • reduce the size of the tumour before radiation therapy or hormone therapy

Find out more about surgery for prostate cancer.

Hormone therapy

Hormone therapy changes the levels of hormones or blocks certain hormones to slow the growth and spread of cancer cells. It may be offered before, during or after radiation therapy for locally advanced prostate cancer. It may also be used alone as a main treatment if you can't have radiation therapy or surgery or if you are elderly and aren't having any symptoms.

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 androgen synthesis inhibitor

  • an orchiectomy (surgery to remove the testicles)

Find out more about hormone therapy 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.

Expert review and references

  • Peter Chung, MBChB, FRCPC
  • Krista Noonan, MD, FRCPC
  • American Cancer Society. Treating Prostate Cancer. 2019:
  • American Society of Clinical Oncology. Prostate Cancer. 2020:
  • Tracy, CR. Prostate Cancer. eMedicine/Medscape; 2020:
  • Garnick MB (ed.). Harvard Medical School 2015 Annual Report on Prostate Diseases. 2015.
  • Mir MC, Stephenson AJ . Expectant management of localized prostate cancer. Nargund VH, Raghavan D, Sandler HM (eds.). Urological Oncology. Springer; 2015: 41: 719-730.
  • PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment (PDQ®)–Patient Version. Bethesda, MD: National Cancer Institute; 2020:
  • PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment (PDQ®)–Health Professional Version. Bethesda, MD: National Cancer Institute; 2020:
  • National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer (Version 3.2020) . 2020 .
  • Princess Margaret Cancer Centre. Princess Margaret Cancer Centre Clinical Practice Guidelines: Prostate Cancer. 2015:
  • Zelefsky MJ, Morris MJ, Eastham JA. Cancer of the prostate. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds.. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 70: 1087-1136.
  • Parker C, Castro E, Fizazi K et al . Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up . Annals of Oncology . 2020 : 31(9): 1119-1134 .

Medical disclaimer

The information that the Canadian Cancer Society provides does not replace your relationship with your doctor. The information is for your general use, so be sure to talk to a qualified healthcare professional before making medical decisions or if you have questions about your health.

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