SUMMARY
Localized prostate cancer is cancer that remains confined to the prostate gland and is often detected early. This article explains the main treatment options, including surgery, radiation therapy, ablation methods, and active surveillance. It outlines how each works, and how doctors match treatments to tumor characteristics and patient priorities to control cancer yet minimize side effects.
What is localized prostate cancer?
Localized prostate cancer means cancer that is still contained in the prostate gland. It has not yet extended beyond the prostate capsule. Most prostate cancer is found early before it has begun to spread. According to government statistics, in the U.S. from 2018 to 2022, 70% of prostate cancer cases were diagnosed at a localized stage.
When localized prostate cancer is found at an early, localized stage, a range of treatment choices is available, with success rates that approach 100% at five years after treatment.
The ProtecT trial found that 97% of patients diagnosed with localized prostate cancer survived their cancer 15 years after diagnosis regardless of which treatment they received.[i] About 97% of the men diagnosed with prostate cancer survived 15 years after diagnosis, regardless of their treatment choice.
Dr. Dan Sperling, Medical Director of the Sperling Prostate Center, points out that early detection is very important. At that point, all treatment options are open. In addition, a patient may qualify for an MRI-guided focal therapy as offered by Dr. Sperling. The aim of focal therapy is to ablate (destroy) the prostate cancer while preserving healthy gland function and quality of life.
What are the treatment choices for localized prostate cancer?
There are four general treatment strategies for localized prostate cancer.
- Radical prostatectomy (intervention by surgical removal of the prostate)
- Radiotherapy (intervention by radiation) may be delivered by external beam (beam radiation) or by implanting radioactive seeds throughout the gland (brachytherapy).
- Ablation (intervention by destruction of tissue) involves applying a source of energy to destroy tissue. It may be done as a radical (whole gland) procedure or a partial gland procedure.
- Active Surveillance may be recommended for early stage, low-risk localized prostate cancer. This strategy holds off on an immediate intervention. Instead, the patient goes on a program of monitoring for disease progression. Monitoring consists of PSA tests and prostate imaging (multiparametric MRI) at regular intervals. A change in PSA and/or imaging may trigger a biopsy; biopsy results may trigger intervention.
What is radical prostatectomy for localized prostate cancer?
Radical prostatectomy is surgery. It involves removing the entire prostate, seminal vesicles, nearby tissues, the vas deferens, and sometimes pelvic lymph nodes. Depending on tumor location, one or both of the neurovascular bundles that control erection may be spared.
Are there different methods to perform prostatectomy?
There are three methods of performing radical prostatectomy.
- Open prostatectomy is the most invasive and is now rarely done in favor of less invasive surgery.
- Laparoscopic prostatectomy is less invasive because the doctor makes several small incisions and inserts a hand-held camera scope and surgical instruments. The surgery is done by hand.
- Robotic-assisted laparoscopic surgery is the least invasive. It is performed by robotic arms equipped with very small surgical instruments and camera scopes. The doctor sits at a nearby console. From there he views the internal organs with high magnification, and controls the movements of the robotic arms. The magnification and small instruments allow great precision.
What is radiotherapy for localized prostate cancer?
Radiotherapy is radiation. It involves damaging the DNA of cancer cells so they are unable to reproduce. Radiation does not immediately destroy the cancer. Over time the cells die off. This is why exposure to radiation must continue for a period of time. The strategy is to concentrate radiation on the prostate.
There are three types of beam radiotherapy most commonly used for localized prostate cancer.
- Intensity-modulated radiation therapy (IMRT) involves several weeks of daily treatment sessions. uses computer calculations to focus radiation on the prostate to reduce damage to nearby structures like the bladder and rectum.
- Stereotactic body radiation therapy (SBRT) involves fewer radiation sessions because high radiation doses are delivered from may angles to the prostate, designed to be more precise in avoiding nearby healthy structures.
- Proton beam radiation involves several weeks of daily sessions. It is considered more precise and less damaging to nearby structures because proton beam behaves differently than the kind of x-ray beams in other radiation methods.
Brachytherapy (seed implants) is another radiation method. Instead of beams, small radioactive pellets (seeds) are permanently implanted throughout the gland. A tighter concentration of seeds may be focused on the tumor. The initials radiation dose is high, when it has the greatest effect. Over time, the cancer cells die off and the radiation diminishes.
What is ablation and how does it work for localized prostate cancer?
Ablation is a minimally invasive method for destroying cancer tumors by applying an energy source. Unlike radiation, which takes time to cause cancer to die off, ablation immediately destroys cells in the body. No surgery or radiation is necessary.
What are the different ablation methods for localized prostate cancer?
Here are image-guided methods most often used to ablate localized prostate cancer tumors.
- Focal laser ablation (FLA) creates lethal heat by inserting a fiber optic into the core of the tumor. MRI is used to guide the fiber applicator to its target. When activated, laser light generates heat to destroy the tumor. It is done as a focal therapy to destroy the targeted tumor.
- High intensity focused ultrasound (HIFU) creates lethal heat by beaming sonic energy (directional ultrasound) to the target area. Transrectal ultrasound (TRUS) is used to plan and guide treatment. HIFU can be done as a whole-gland, partial-gland, or focal treatment.
- Cryotherapy (cryo) creates a lethally cold iceball out of the targeted tissue. It can be done as a whole-gland, partial-gland, or focal treatment.
- Transurethral Ultrasound Ablation of the Prostate (TULSA-PRO or TULSA) uses directional ultrasound to destroy tissue. MRI is used to plan and guide the applicator inserted into the urethra. It can be done as a whole-gland, partial gland, or focal treatment.
- MRI-guided Focused Ultrasound (Exablate) uses the same principle as TRUS-guided HIFU but the delivery is guided by live MRI in a specially adapted MRI magnet rather than a transrectal ultrasound probe.
Other emerging ablation methods are Irreversible Electroporation (IRE or NanoKnife), photodynamic treatment, and radiofrequency ablation (RFA).
What is the best treatment choice for localized prostate cancer?
There is no single, universal treatment choice that fits every case of localized prostate cancer. Some tumors are small and nonaggressive, while others are large and more dangerous. Thorough diagnosis is necessary.
The doctor orders tests and MRI to determine the exact characteristics and nature of each patient’s cancer. This includes patient age, PSA, Gleason grade, tumor stage, genomic or molecular characteristics to rule out dangerous mutations, family history of cancer, race/ethnicity, etc. which are physical factors. Lifestyle and personal preferences may also play a role in treatment choice.
When all the tumor characteristics are known, the doctor and patient discuss which treatment choice(s) best accomplish the dual goal of controlling the cancer while reducing side effect risks (urinary, sexual).
Thus, the best treatment for localized prostate cancer is the one that is the best “fit” for the patient’s clinical needs and lifestyle preferences. While patients are encouraged to do their own research, the final decision should be made in consultation with the doctor, based on all personal test results.
Dr. Sperling and his experienced staff provide thorough and compassionate diagnosis to plan localized prostate cancer treatment that best fits each patient’s needs. For more information, contact the Sperling Prostate Center.
Frequently Asked Questions: Localized Prostate Cancer Treatment
Q: What kinds of tests are used to diagnose prostate cancer?
A: Typical tests to diagnose prostate cancer include blood work (PSA, PSA density), multiparametric MRI with PI-RADS score, needle biopsy to determine aggression level (Gleason score). Pending test results and risk factors like family history of prostate cancer, additional tests may be ordered such as genomic analysis and PSMA-PET scan.
Q: What are the side effects of treatment?
A: As a rule of thumb, the more aggressive the treatment, the greater the risk of side effects. In the majority of cases, side effects do not occur or are mild and resolve quickly. Possible treatment side effects are urinary incontinence (leaking urine), sexual dysfunction, and bowel problems after radiation. Some side effects may resolve on their own. Side effects may be short-term or longer-term, even permanent. After radiation, there may be late onset side effects. However, there are excellent treatments for side effects, so patients should not be discouraged if there are side effects.
Also, focal therapies like Focal Laser Ablation or other methods greatly reduce the risk of side effects because the spare healthy tissue and thus preserve urinary, sexual and bowel function.
Content reviewed by Dr. Dan Sperling, M.D., DABR — updated January 2026.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Hamdy FC, Donovan JL, Lane JA, Metcalfe C et al. Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer. N Engl J Med. 2023 Apr 27;388(17):1547-1558.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
