Localised prostate cancer, high and very high risk
High-risk prostate cancer has Grade Group 4 or 5 disease, a PSA above 20 or a tumour growing beyond the gland. It is still curable, but needs radiotherapy with two to three years of hormone therapy, or surgery followed by radiotherapy, and adding abiraterone to hormone therapy now lengthens life in the highest-risk men.
Overview
High-risk localised prostate cancer is defined by the NCCN as any of clinical stage T3a, Grade Group 4 or 5, or PSA above 20 ng/mL; very high risk adds T3b to T4 disease, primary Gleason pattern 5, more than four cores of Grade Group 4 or 5, or two or more high-risk features. It is found by PSA and biopsy and staged with PSMA PET, which proPSMA showed is far more accurate than CT and bone scan. Standard treatment is external beam radiotherapy to the prostate and pelvic nodes with 18 to 36 months of androgen deprivation, often with a brachytherapy boost, or radical prostatectomy with extended node dissection followed by radiotherapy when the pathology warrants it. STAMPEDE showed that adding two years of abiraterone to androgen deprivation and radiotherapy in men with very high risk or node-positive disease cuts metastasis and death, and this is now guideline care for the highest-risk group. Salvage options after failure are covered under biochemical recurrence.
State of the art
- PSMA PET has replaced bone scan and CT for staging, reclassifying about a quarter of men.
- Abiraterone with radiotherapy and hormone therapy is the first drug to improve survival in high-risk non-metastatic disease.
- Genomic classifiers and AI pathology are being tested to choose hormone therapy duration.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBlood clot (tamoxifen and others)
A swollen painful calf, or sudden breathlessness with chest pain; the tamoxifen boxed warning covers pulmonary embolism and stroke.
- Check before combiningFood and drink: Abiraterone acetate
Take on an empty stomach: food raises exposure up to tenfold and increases toxicity. Prednisone 5 mg covers mineralocorticoid excess.
- Check before combiningLiver: Abiraterone acetate
Reduce to 250 mg daily in moderate impairment; avoid in severe.
See all on the product pages:Abiraterone acetateDegarelixLeuprolide (leuprorelin) and GnRH agonistsRelugolix·Printable cards in the navigator
Anatomy and lymph node drainage
- Peripheral zone (most cancers)
- Transition zone (BPH)
- Ducts (ductal, intraductal, neuroendocrine)
- Seminal vesicle (T3b)
- Nodes: obturator
- Nodes: internal iliac
- Nodes: external iliac
- Nodes: presacral
About three quarters of cancers arise in the peripheral zone at the back of the gland, the part a finger or a biopsy needle reaches; drainage is to the obturator and iliac nodes.
- Peripheral zone (most cancers)High risk (T3a, or Grade Group 4 or 5, or PSA above 20) · Locally advanced adenocarcinoma with seminal vesicle invasion (T3b)
- Transition zone (BPH)
- Ducts (ductal, intraductal, neuroendocrine)
- Seminal vesicle (T3b)High risk (T3a, or Grade Group 4 or 5, or PSA above 20) · Very high risk (T3b to T4, primary pattern 5, more than 4 high-grade cores, or 2 or more high-risk features) · Locally advanced adenocarcinoma with seminal vesicle invasion (T3b)
- obturator
- internal iliac
- external iliac
- presacral
Same organ: Prostate cancer, Localised prostate cancer, very low and low risk, Localised prostate cancer, intermediate risk, Biochemical recurrence of prostate cancer, Metastatic hormone-sensitive prostate cancer, Non-metastatic castration-resistant prostate cancer, Metastatic castration-resistant prostate cancer, Neuroendocrine and small-cell prostate cancer
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- About one in five newly diagnosed localised cancers and most of the deaths from disease found before it spreads; ten-year cancer-specific survival is around 85 percent with combined treatment.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
External beam radiotherapy to prostate and pelvic nodes with 18 to 36 months of androgen deprivation, with or without brachytherapy boost; or radical prostatectomy with extended lymph node dissection.
Radiotherapy plus androgen deprivation with two years of abiraterone (STAMPEDE); PSMA PET staging before treatment.
Adjuvant or early salvage radiotherapy guided by PSA, with hormone therapy for higher-risk features.
Subtypes & biomarkers
top- High risk (T3a, or Grade Group 4 or 5, or PSA above 20)
- Very high risk (T3b to T4, primary pattern 5, more than 4 high-grade cores, or 2 or more high-risk features)
- Locally advanced adenocarcinoma with seminal vesicle invasion (T3b)
- Clinically node-positive (N1) non-metastatic disease
- Gleason Grade Group 4 or 5
- PSA above 20 ng/mL
- PSMA PET staging
- Germline and tumour HRR testing (BRCA2 in particular)
- Decipher genomic classifier
How often this target appears
- 1997EORTC 22863: adding three years of hormone therapy to radiotherapy improves survival
- 2009Long-course beats short-course androgen deprivation with radiotherapy in high-risk disease
- 2020proPSMA: PSMA PET more accurate than conventional staging
- 2022STAMPEDE: abiraterone improves survival in high-risk non-metastatic disease
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 8 changes by month →- 2026-09-17This recordLocalised prostate cancer, high and very high riskFacts on this page last checked
When this page itself was last checked or edited.
- 2022MilestoneSTAMPEDESTAMPEDE: abiraterone improves survival in high-risk non-metastatic disease
A milestone in how this cancer is treated.
- 2020Trial resultproPSMAproPSMA reported
Accuracy 92% vs 65%.
- 2020MilestoneproPSMAproPSMA: PSMA PET more accurate than conventional staging
A milestone in how this cancer is treated.
- 2019Trial resultHYPO-RT-PCHYPO-RT-PC reported
5-year failure-free survival 84% in both arms, non-inferior.
- 2016Trial resultSTAMPEDESTAMPEDE reported
Abiraterone + ADT: OS HR 0.
What is in development for Localised prostate cancer, high and very high risk, drawn from the whole corpus: 4 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Technologies being tested · 1
Trials reported · 3
- HYPO-RT-PC · phase 3 · 2019 · positive
- proPSMA · phase 3 · 2020 · positive
- STAMPEDE · phase platform · 2016 · positive
Open problems and what is being done
How long hormone therapy should last when abiraterone is added.
Whether PSMA PET-detected nodes should change treatment when the trials were staged conventionally.
Which men with high-risk disease are better served by surgery than radiotherapy.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
London · cancer center | United Kingdom | none recorded | 1 | 1,026 | 17,745 | #7 | |
Melbourne · cancer center | Australia | none recorded | 1 | 1,547 | 24,196 | #14 | |
Seoul · hospital | South Korea | none recorded | 0 | 464 | 3,248 | #22 | |
Munich · university | Germany | none recorded | 0 | 1,937 | 23,450 | #31 | |
San Francisco · cancer center | United States | 0 | 2,800 | 46,704 | #33 | ||
London · hospital | United Kingdom | none recorded | 1 | 2,376 | 28,940 | - | |
London · research institute | United Kingdom | none recorded | 1 | 641 | 10,459 | none recorded | - |
Sydney · consortium | Australia | none recorded | 1 | 3 | 3 | - | |
London · consortium | United Kingdom | none recorded | 1 | not matched | - | none recorded | - |
Shanghai · hospital | China | none recorded | 0 | 2,872 | 31,534 | - | |
Sydney · cancer center | Australia | none recorded | 0 | 2,222 | 33,278 | - | |
Los Angeles · cancer center | United States | 0 | 2,019 | 32,934 | - | ||
Beijing · hospital | China | none recorded | 0 | 1,784 | 18,230 | - | |
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Guangzhou · hospital | China | none recorded | 0 | 1,245 | 12,931 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Localised prostate cancer, high and very high risk but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Localised prostate cancer, high and very high risk
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Gleason Grade Group 4 or 5, PSA above 20 ng/mL, PSMA PET staging, Germline and tumour HRR testing, Decipher genomic classifier), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include High risk, Very high risk, Locally advanced adenocarcinoma with seminal vesicle invasion.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
High risk
- For my situation (high risk), which of the standard options do you recommend and why?Why: Guideline options include: External beam radiotherapy to prostate and pelvic nodes with 18 to 36 months of androgen deprivation, with or without brachytherapy boost; or radical prostatectomy with extended lymph node dissection.
- Am I a candidate for Leuprolide (leuprorelin) and GnRH agonists, Degarelix, Relugolix, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of HYPO-RT-PC apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Very high risk and node-positive
- For my situation (very high risk and node-positive), which of the standard options do you recommend and why?Why: Guideline options include: Radiotherapy plus androgen deprivation with two years of abiraterone (STAMPEDE); PSMA PET staging before treatment.
- Am I a candidate for Abiraterone acetate, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of STAMPEDE and proPSMA apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
After prostatectomy with adverse pathology
- For my situation (after prostatectomy with adverse pathology), which of the standard options do you recommend and why?Why: Guideline options include: Adjuvant or early salvage radiotherapy guided by PSA, with hormone therapy for higher-risk features.
Any stage
- Are there clinical trials I could join, for example of PSMA PET, ArteraAI Prostate, Decipher Prostate, Abiraterone acetate?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “How long hormone therapy should last when abiraterone is added”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Whether PSMA PET-detected nodes should change treatment when the trials were staged conventionally”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Localised prostate cancer, high and very high risk, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
10targets
1drugs
6companies
9terms
2trials
3Latest papers
topQuery for this cancer: (TITLE:"Localised prostate cancer, high and very high risk" OR ABSTRACT:"Localised prostate cancer, high and very high risk" OR TITLE:"High-risk prostate cancer" OR ABSTRACT:"High-risk prostate cancer" OR TITLE:"Very high risk prostate cancer" OR ABSTRACT:"Very high risk prostate cancer" OR TITLE:"Locally advanced prostate cancer" OR ABSTRACT:"Locally advanced prostate cancer" OR TITLE:"Grade Group 4 and 5 prostate cancer" OR ABSTRACT:"Grade Group 4 and 5 prostate cancer" OR TITLE:"Non-metastatic high-risk prostate cancer" OR ABSTRACT:"Non-metastatic high-risk prostate cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Localised prostate cancer, high and very high risk, not a curated reading list.
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