Prostate cancer is the most common cancer in men, with more than 55,000 new cases each year in the UK. Most men with localised cancer (confined to the prostate) are likely to live for a long time.
Treatment options for localised cancer are based on how likely the cancer is to spread beyond the prostate. Based on the available evidence including findings from the landmark NIHR trial, ProtecT, guidelines from the National Institute for Health and Care Excellence (NICE) recommend offering men with lower risk localised cancer active surveillance, surgery or radiotherapy. Active surveillance means closely monitoring prostate cancer, rather than treating it straight away. Men with a higher risk that their cancer will spread beyond the prostate are recommended surgery or radiotherapy. But more can be done to optimise treatment for the future.
In March 2025, an NIHR Evidence webinar brought together 3 large, ongoing NIHR randomised controlled trials that could improve prostate cancer care. All involve men with localised cancer, but with different levels of risk of their cancer spreading beyond the prostate:
- The ATLAS trial is looking at whether regular MRI scans improve active surveillance in low to medium risk prostate cancer compared to standard care
- The PART trial is examining whether treating only the part of the prostate containing the cancer is as effective as treating the whole prostate, and has fewer side effects, for medium risk prostate cancer
- The ELIPSE trial is looking at whether to remove lymph nodes, as well as the whole prostate, during surgery for high risk prostate cancer.
Could regular MRI scans improve active surveillance for low to medium risk prostate cancer?
Increasing numbers of men with low and certain types of medium risk localised prostate cancer are choosing active surveillance rather than treatment. This is because these cancers grow slowly, or not at all, and treatments can cause side-effects. However, if the cancer does progress, it may be noticed late.
Active surveillance involves regular tests. Currently, NICE recommends prostate specific antigen (PSA) blood tests every 3-6 months and a rectal exam every 12 months. A magnetic resonance imaging (MRI) scan is recommended 12 to 18 months after starting active surveillance if an MRI scan was not done before the first biopsy, or where there is concern about clinical or PSA change. There is some evidence that regular MRI scans could improve active surveillance, but a definitive clinical trial is needed.
At the webinar, Archana Gopalakrishnan, a clinical research fellow in urology at Imperial College London, presented the ATLAS (Approaches To Long-Term Active Surveillance) trial. The trial is exploring whether the addition of regular MRI scans improves on current standard care at detecting progression of prostate cancer. The trial includes men on active surveillance for low to medium risk prostate cancer.
Is limiting treatment to the part of the prostate containing cancer as effective as treating the whole prostate for medium risk cancer?
Treating the whole prostate with surgery or radiotherapy (radical treatment) is effective, but can result in urinary, bowel, and sexual side effects. Some men have cancer on one side of the prostate and new technologies make it possible to treat part of the prostate only (partial ablation). Partial ablation may reduce side effects compared to radical treatment, but a trial is needed to ensure it is safe and effective.
At the webinar, Richard Bryant, Associate Professor of Urology and Clinical Lead for Urology at Oxford University Hospitals NHS Foundation Trust presented the PART trial (A randomised controlled trial of Partial prostate Ablation versus Radical Treatment), which is comparing the effectiveness of the two treatment options for men with medium risk prostate cancer. The findings will provide evidence on the treatments’ comparative benefits and risks to help inform decision-making.
Does removing lymph nodes at the same time as surgery to remove the prostate improve outcomes for localised high-risk prostate cancer?
Surgery to remove the whole prostate (radical prostatectomy) is recommended for people with localised cancer at high risk of spreading beyond the prostate. Some surgeons believe that removing the lymph nodes from the pelvis during surgery can reduce the risk of the cancer returning, but research is limited. Further, removing these lymph nodes can lead to complications, such as swelling in the scrotum, and in one or both legs, which can be painful and limit mobility.
At the webinar, Krishna Narahari, a consultant urologist at the University Hospital of Wales described the ELIPSE Study (a randomised controlled trial comparing the clinical and cost-effectiveness of lymph node removal in patients undergoing curative surgery for localised high-risk prostate cancer). The trial is comparing lymph node removal to no lymph node removal in people with localised high-risk prostate cancer undergoing radical prostatectomy. The findings will help men with prostate cancer and their surgeons make informed decisions about their care.
How to cite this Collection: NIHR Evidence; Prostate cancer research: what's next?; March 2025; doi:
Disclaimer: This publication is not a substitute for professional healthcare advice. It provides information about research which is funded or supported by the NIHR. Please note that views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
NIHR Evidence is covered by the creative commons, CC-BY licence. Written content and infographics may be freely reproduced provided that suitable acknowledgement is made. Note, this licence excludes comments and images made by third parties, audiovisual content, and linked content on other websites.
