# Localised prostate cancer, intermediate risk

Source: https://onco.cc/cancers/prostate-intermediate-risk/  
OnCo record `prostate-intermediate-risk` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Intermediate-risk prostate cancer has Grade Group 2 or 3 disease, a PSA between 10 and 20 or a tumour that fills more of the gland. Surgery or radiotherapy cure most men; the favourable half can sometimes be watched, and the unfavourable half is given a few months of hormone therapy with radiotherapy.

## Summary

Intermediate-risk localised prostate cancer, in the NCCN scheme, has one or more of clinical stage T2b to T2c, Grade Group 2 or 3, or PSA 10 to 20 ng/mL, without high-risk features. It is split into favourable (one factor, Grade Group 1 or 2, under half of cores positive) and unfavourable (two or more factors, Grade Group 3, or more than half of cores positive), because the two behave differently. It is found by PSA, MRI and biopsy and staged clinically; bone scan and CT are reserved for unfavourable disease. Favourable disease is treated by radical prostatectomy, external beam radiotherapy or brachytherapy alone, and active surveillance is an option for selected men. Unfavourable disease is treated by prostatectomy with lymph node dissection, or radiotherapy with four to six months of androgen deprivation, or external beam radiotherapy plus a brachytherapy boost. CHHiP established 60 Gy in 20 fractions, HYPO-RT-PC showed seven fractions are equivalent, and PACE-B showed five stereotactic fractions match conventional radiotherapy at five years. Genomic classifiers and the ArteraAI pathology test are used to decide whether hormone therapy adds anything.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Intermediate-risk prostate cancer; Favourable intermediate risk; Unfavourable intermediate risk; Grade Group 2 and 3 prostate cancer
- Tags: subtype-page
- Group: genitourinary
- Burden: About four in ten newly diagnosed localised prostate cancers; ten-year cancer-specific survival is above 95 percent with treatment.
- Subtypes: Favourable intermediate risk (one factor, Grade Group 1 or 2, under half of cores); Unfavourable intermediate risk (two or more factors, Grade Group 3, or more than half of cores); Localised acinar adenocarcinoma, Grade Group 2 or 3; Cribriform or intraductal pattern (behaves as unfavourable)
- Biomarkers: Gleason Grade Group 2 or 3; PSA 10 to 20 ng/mL; Percentage of positive cores; Cribriform or intraductal carcinoma; Decipher genomic classifier and ArteraAI Prostate for hormone therapy decisions

## Standard of care

- Favourable intermediate risk: Radical prostatectomy, external beam radiotherapy (moderate or ultra-hypofractionated) or brachytherapy alone; active surveillance for selected men with low volume Grade Group 2 disease. ([Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/), [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [Active surveillance](https://onco.cc/technologies/active-surveillance/), [CHHiP](https://onco.cc/trials/chhip/), [PACE-B](https://onco.cc/trials/pace-b/))
- Unfavourable intermediate risk: Radical prostatectomy with pelvic lymph node dissection, or external beam radiotherapy with four to six months of androgen deprivation, or external beam plus brachytherapy boost. ([Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [Androgen deprivation & AR pathway inhibitors](https://onco.cc/technologies/androgen-deprivation/), [Leuprolide (leuprorelin) and GnRH agonists](https://onco.cc/drugs/leuprolide/), [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [HYPO-RT-PC](https://onco.cc/trials/hypo-rt-pc/))
- Deciding on hormone therapy: ArteraAI Prostate predicts benefit from short-course androgen deprivation with radiotherapy; Decipher stratifies risk. ([ArteraAI Prostate](https://onco.cc/drugs/artera-ai-prostate/), [Decipher Prostate](https://onco.cc/drugs/decipher-prostate/), [Digital pathology & AI](https://onco.cc/technologies/digital-pathology-ai/))

## State of the art

- Radiotherapy has shrunk from eight weeks to one to two, with the same control and side effects.
- The favourable and unfavourable split lets half of these men avoid hormone therapy.
- AI pathology trained on trial specimens now tells which men gain from hormone therapy.

## Open problems

- Whether favourable intermediate risk can be safely watched in the long term.
- How to select men for hormone therapy without giving it to everyone in the unfavourable group.
- Cribriform and intraductal patterns are prognostic but not yet in the risk groups.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Prostate_cancer_staging
- Wikipedia: https://en.wikipedia.org/wiki/Prostate_cancer_staging
- NCCN Guidelines: Prostate Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459

## Connected records

- terms: [Gleason score / Grade Group](https://onco.cc/terms/gleason-grade-group/)
- trials: [CHHiP](https://onco.cc/trials/chhip/), [HYPO-RT-PC](https://onco.cc/trials/hypo-rt-pc/), [PACE-B](https://onco.cc/trials/pace-b/), [ProtecT](https://onco.cc/trials/protect/)
- drugs: [ArteraAI Prostate](https://onco.cc/drugs/artera-ai-prostate/), [Decipher Prostate](https://onco.cc/drugs/decipher-prostate/), [Leuprolide (leuprorelin) and GnRH agonists](https://onco.cc/drugs/leuprolide/)
- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [Androgen deprivation & AR pathway inhibitors](https://onco.cc/technologies/androgen-deprivation/), [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [Digital pathology & AI](https://onco.cc/technologies/digital-pathology-ai/), [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Robotic & minimally invasive surgery](https://onco.cc/technologies/robotic-surgery/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- cancers: [Prostate cancer](https://onco.cc/cancers/prostate/)

---
JSON: https://onco.cc/api/v1/entities/prostate-intermediate-risk.json