Initial Prostate Cancer Diagnosis:

Intermediate Risk (Favorable)

Doctors use disease features including (but not limited to) those listed below
to determine prostate cancer risk group.

Patients with an initial diagnosis that includes one of the following: Gleason 7/Grade Group 2, PSA 10-20, or cancer involves more than one-half of one side of the prostate or involves both sides of the prostate.

Understanding Your Risk Level

Years of Life Expectancy

Treatment Options

5 – 10

PSA every 6-12 mo for 5y then every year. Consider physical exam if suspicious of return.
External Beam Radiation Therapy (EBRT)
Brachytherapy

Greater Than 10

Active surveillance
Radiation therapy
- PSA recurrence
  - External Beam Radiation Therapy (ERBT)
  - Brachytherapy
- No PSA recurrence (monitor)
Radical prostatectomy (RP)
- Undetectable PSA
  - No adverse features and no lymph node metastases (monitor)
  - Adverse features or lymph node metastases, monitoring is preferred or consider treatment
- PSA persistence
  - ERBT +/- ADT (preferred) or monitoring
  - ERBT + ADT or ERBT + ADT+ abiraterone

CLINICAL TRIALS:
NCCN believes that the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is especially encouraged.

NOTE:
For asymptomatic patients in very low, low, and intermediate, risk groups with life expectancy less than 5 years no imaging or treatment is indicated until patient becomes symptomatic.

Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Prostate Cancer Version 4.2023
© National Comprehensive Cancer Network, Inc. 2022. All rights reserved. The complete and current version of the guideline is available at NCCN.org.

IMPORTANT:

This information is provided for educational purposes only to support patients in understanding and discussing appropriate treatment options with their doctors. Included is information from treatment guidelines for doctors and other sources. However, this information should not be considered as patient treatment guidelines or recommendations, but as educational materials only. Patients should discuss treatments identified herein with their doctors to understand the risks and benefits of each based on their personal diagnosis. Treatment decisions should only be made between the patient and his doctor.