Localized prostate cancer simply means the tumor cells have not spread beyond the prostate – a gland in men that makes fluid that becomes part of semen. It’s the earliest and least dangerous phase of the disease. You and your doctor have many things to consider as you decide whether and how to treat it.
What Are Symptoms of Localized Prostate Cancer?
You might not have any symptoms if your prostate cancer is localized. Many symptoms don’t appear until the cancer has gotten large or has started to spread. But, you may have:
How Is Localized Prostate Cancer Diagnosed?
Most men find out they have prostate cancer through a routine screening. The recommended ages for screenings are 55-69. But you might get a test earlier if you are at higher risk. Black men are at higher risk. So are people who have close family members with certain types of cancer, especially if family members get the cancer early.
- Prostate-specific antigen (PSA) test. This measures the amount of a protein made by the prostate that’s in your bloodstream. The higher it is, the greater the chance you have prostate cancer.
- Digital rectal exam. A doctor feels inside your rectum for bumps or hard areas on the prostate. But localized prostate tumors are often too small to be found this way.
If your results are suspicious, your doctor may order another PSA test or an imaging test like an MRI or ultrasound. But to know for sure if you have prostate cancer, you’ll need a needle biopsy. Your doctor will take tissue samples from different areas of your prostate and check them under a microscope.
Grading and Staging of Localized Prostate Cancer
Part of the diagnosis of prostate cancer is assigning it a grade and a stage.
Grade. This number shows how aggressive the cancer appears to be. “Aggressive” is another way of saying that your cancer grows or spreads quickly. Doctors base the grade on how the cells look under a microscope. The more packed the cells are and the more irregular or misshapen the cells are, the higher the grade.
They assign what's called a Gleason score based on how different the cancer tissue is from normal prostate tissue. The lower the number, the less likely the cancer will grow and spread quickly.
Stage. This combines information about the tumor grade and size, whether it’s spread beyond the prostate, and the level of PSA in your blood. The stage is expressed with roman numerals (I-IV). The lower the number, the less advanced the cancer.
Most localized prostate cancer is either stage I or II.
What Are the Risk Groups for Localized Prostate Cancer?
Localized prostate cancer usually grows slowly. Many men never even know they have it.
To decide how to treat your cancer, you and your doctor will need to know how likely it is to spread. Doctors assign your stage I-III cancer to a risk group to help you understand how aggressive it may be. (These do not apply to stage IV, which already has spread.)
- Very low risk: These tumors are small, within the prostate, and low-grade. Your PSA is below 10.
- Low risk: These are a bit larger, but are still only in the prostate. They have a low grade and PSA.
- Intermediate risk: In this group, the tumor is still within the prostate but may be large enough to be felt in an exam or seen on an imaging test. The grade may be higher, and your PSA level is between 10 and 20.
- High risk: Many tumors in this group have grown outside the prostate. But you can still have localized prostate cancer and fall into this group if the tumor has a high grade or your PSA is more than 20.
- Very high risk: These tumors have also probably grown outside the prostate. But you might be in the group if your localized tumor has a high grade and your PSA level is also high.
If your doctor needs more information to decide your risk level, they may give you tests to measure the activity of certain genes or proteins inside your cancer cells. That can help them figure out whether the cancer might grow and spread quickly. Or, if you’ve had surgery, it can help your doctor predict whether the cancer might come back in other parts of your body.
What’s the Treatment for Localized Prostate Cancer?
You and your doctor have several treatment options to choose from, from simply keeping an eye on your condition to surgery. Many prostate cancers progress so slowly, you may not need to be treated right away, if ever.
You should consider how likely it is your cancer will get worse, along with the possible side effects and complications of treatment. Your overall health also comes into play. And your age is especially important, particularly if you’re older than 70.
For localized prostate cancer, choices include:
Watchful waiting. This means no treatment of the cancer itself, but managing any symptoms. It may make the most sense if you’re older or have health problems when you’re diagnosed, and the possible benefits of other treatments aren’t worth the risk.
Active surveillance. This is a less conservative approach than watchful waiting, for low- or very low-risk tumors. You’ll get regular PSA tests, digital rectal exams, and biopsy or imaging tests. If your cancer gets worse, you may then choose a direct treatment.
Surgery. Your doctor may remove the entire prostate, either in an open or laparoscopic procedure. This may be a good option if you’re healthy overall and expect to live at least another 10 years. But it also can cause incontinence – which is loss of bladder control – and erectile dysfunction.
Radiation. This kills cancer cells in one of two ways: A machine can direct X-rays at the prostate gland from outside the body, or radioactive particles may be put into the prostate. It may be best if you want to get rid of the cancer but can’t have surgery. It also can cause incontinence and erectile dysfunction.
Black men may need to weigh these options differently than men of other races. Scientists aren’t sure why, but Black men often have more aggressive tumors that grow and spread quickly. Even prostate tumors considered low-grade are more likely to be deadly in Black men.
How Are Localized, Locally Advanced, and Metastatic Prostate Cancer Different?
Prostate cancer that has grown beyond the gland itself is no longer considered localized. It’s called “locally advanced” if it has spread outside the prostate into the seminal vesicles, or possibly the rectum, bladder, pelvic wall, or the urethral sphincter – the muscle that controls urination. Treatment options are similar as with localized prostate cancer.
Advanced or metastatic prostate cancer has spread to the lymph nodes, or through the bloodstream or lymph system to other parts of the body, like organs and bones. Treatment may include radiation, chemotherapy, and hormone therapy.
What’s the Outlook for Localized Prostate Cancer?
The survival rate for men diagnosed with localized prostate cancer is excellent. Almost everyone has as good a chance of living at least 5 years as men who don’t have prostate cancer. And cancer at this stage can be cured with surgery or radiation.
If the cancer is diagnosed as locally advanced, it usually isn’t possible to cure it. But the survival rate is the same at 5 years as for people without prostate cancer.
The outlook is not as good if the cancer has already spread to the lymph system or other body parts. Most men diagnosed with metastatic prostate cancer don’t live beyond 3 years. But the vast majority of prostate cancer is caught while it’s still treatable.