The Cambridge Prognostic Score combines the Gleason score or grade, PSA level and T stage to assess PC that has not spread. The cancer is ranked low to high risk in one of five prognostic groups, CPG1 to CPG5, helping to inform the approach to treatment. It is not used for PC that has spread, which is treated as metastatic or advanced PC.³²

Non-drug approaches are recommended for lower risk PC. Depending on the patient, watchful waiting (where the patient does not want curative treatment) or active surveillance may be sufficient, with regular monitoring by scans and blood tests.^34,35

However, core treatment options at this level are:^34,35,36

·     - surgery (radical prostatectomy is the removal of the whole prostate); or

·     - radiotherapy delivered externally as high energy X-ray beams or as radioactive pellets inserted into the prostate (permanent seed brachytherapy).

Common side effects are long-term urinary incontinence and erectile dysfunction, and bowel problems for some. PSA levels are monitored even once the prostate has been removed.³⁴

Less widely available are newer minimally invasive focal treatments: HIFU (high intensity focal ultrasound); cryotherapy of targeted ice ablation therapy; and irreversible electroporation using an electric current to kill cells.³⁷

Radical prostatectomy or radical radiotherapy can be an option for higher risk (CPG 4/5) when it is likely the cancer can be controlled in the long term. However, hormone therapy becomes a core recommendation at this level or if it has metastasised.³⁴