Localised and Locally Advanced Prostate Cancer
Treatment options and management strategies for localised and locally advanced disease.
Treatment Options (1.3.1-1.3.2)
Localised Prostate Cancer
Discuss these management options:
- • Active Surveillance - Regular monitoring with curative treatment if progression detected
- • Radical Prostatectomy - Surgical removal of the prostate
- • Radical Radiotherapy - External beam radiation therapy
Locally Advanced Prostate Cancer
Discuss these management options:
- • Radical Prostatectomy - Surgical removal of the prostate
- • Radical Radiotherapy with Hormone Therapy - Combination approach
Note: Follow NICE guideline on shared decision making when discussing management options with patients.
Active Surveillance
Eligibility (1.3.4)
Offer active surveillance to people with:
Low Risk:
T1/T2, Gleason grade group 1, PSA <10 ng/ml
Intermediate Risk:
T1/T2, Gleason grade group 2-3, PSA <20 ng/ml
Monitoring Protocol (1.3.6)
For people on active surveillance:
- • PSA test every 3-4 months
- • Multiparametric MRI at 12-18 months
- • Prostate biopsy at 12-18 months if MRI shows change in Likert score
- • Consider repeat biopsy at 3-5 years if MRI at 12-18 months is negative
When to Offer Radical Treatment (1.3.8-1.3.9)
Offer Radical Treatment if:
- • MRI Likert score changes to 4 or 5, OR
- • Biopsy changes to Gleason grade group 3 or more
Consider Radical Treatment if:
- • MRI Likert score changes to 3, OR
- • Biopsy changes to Gleason grade group 2
Radical Radiotherapy
Radiotherapy Recommendations (1.3.10-1.3.12)
Locally Advanced Cancer:
External beam radiotherapy with hormone therapy
Localised Low/Intermediate Risk:
External beam radiotherapy alone
Localised High Risk:
External beam radiotherapy with hormone therapy
Note: Do NOT offer high-intensity focused ultrasound or cryotherapy as primary treatment for localised prostate cancer, unless as part of a clinical trial.