Treatment Options for Localised Prostate Cancer
What each option involves.
For localised prostate cancer there is rarely a single right answer. Active surveillance, surgery and radiotherapy can all control the cancer well, and for selected men focal therapy is an option. Because the cancer outcomes are often broadly similar, the decision usually comes down to the side effects you would most want to avoid, and how you feel about monitoring versus treating.
This page is a tool to use before and during your consultation.
Treatment options
Not every option is open to every man. Your risk group narrows the field before your preferences enter the picture.
| If your cancer is | Options usually open | Options usually not offered |
|---|---|---|
| Low risk | Active surveillance is usually preferred; surgery and radiotherapy remain available for men who would rather not monitor | Focal therapy is not usually offered, as immediate treatment is not usually needed |
| Favourable intermediate risk | Surveillance in selected cases, surgery, radiotherapy (hormone therapy not usually needed), focal therapy in selected cases within a registry or trial | — |
| Unfavourable intermediate risk | Surgery, radiotherapy with hormone therapy | Surveillance; focal therapy in most cases |
| High risk | Surgery, radiotherapy with hormone therapy | Surveillance; focal therapy |
What happens with each treatment option?
| What to compare | Active surveillance | Surgery | Radiotherapy | Focal therapy |
|---|---|---|---|---|
| What it involves | Regular PSA, periodic MRI, repeat biopsy | One operation, 1–2 nights in hospital | Daily treatments over several weeks | One procedure, usually day case |
| Time to get through it | Ongoing, indefinitely | Weeks | Weeks to months | Days |
| Catheter afterwards | None | About 10 days | None | About a week |
| Urinary control | Unaffected | Leakage at first; some recover within weeks, most by 6 weeks–6 months | Usually less early effect; can change over years | Usually preserved |
| Erections | Unaffected | Often reduced; recovery over 12 months | Often reduced gradually over years | Aim is to preserve; varies |
| Ejaculation | Unaffected | Stops permanently | Usually reduced | Usually preserved |
| Bowel effects | None | Rare | Possible, may persist | Rare |
| If cancer returns | Treat with intent to cure | Radiotherapy usually possible | Salvage surgery is possible in selected men but carries a much higher risk of incontinence; salvage ablation or brachytherapy may also be considered | Repeat, or surgery or radiotherapy |
| Monitoring afterwards | Central to the approach | PSA every 3–6 months | PSA every 3–6 months | PSA, MRI and a planned repeat biopsy |
It is important to take time to think about your treatment options and consider a second opinion if needed — see second opinions.
Have a question about this condition?
Dr Tan consults at SJMC, Kuala Lumpur.