Localised prostate cancer, intermediate risk
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.
Overview
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.
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.
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.
See all on the product pages:Leuprolide (leuprorelin) and GnRH agonists·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)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
- Transition zone (BPH)
- Ducts (ductal, intraductal, neuroendocrine)Cribriform or intraductal pattern (behaves as unfavourable)
- Seminal vesicle (T3b)
- obturator
- internal iliac
- external iliac
- presacral
Same organ: Prostate cancer, Localised prostate cancer, very low and low risk, Localised prostate cancer, high and very high 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 four in ten newly diagnosed localised prostate cancers; ten-year cancer-specific survival is above 95 percent with 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.
Radical prostatectomy, external beam radiotherapy (moderate or ultra-hypofractionated) or brachytherapy alone; active surveillance for selected men with low volume Grade Group 2 disease.
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.
ArteraAI Prostate predicts benefit from short-course androgen deprivation with radiotherapy; Decipher stratifies risk.
Subtypes & biomarkers
top- 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)
- 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
How often this target appears
- 2014Zumsteg proposes favourable and unfavourable intermediate risk
- 2016CHHiP: 60 Gy in 20 fractions non-inferior to 74 Gy in 37
- 2019HYPO-RT-PC: seven fractions match 39
- 2024PACE-B: stereotactic radiotherapy in five fractions non-inferior
- 2025ArteraAI Prostate: first predictive AI pathology test
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 10 changes by month →- 2026-09-17This recordLocalised prostate cancer, intermediate riskFacts on this page last checked
When this page itself was last checked or edited.
- 2025MilestoneArteraAI ProstateArteraAI Prostate: first predictive AI pathology test
A milestone in how this cancer is treated.
- 2024Trial resultPACE-BPACE-B reported
5-year biochemical or clinical failure-free 95.
- 2024MilestonePACE-BPACE-B: stereotactic radiotherapy in five fractions non-inferior
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.
- 2019MilestoneHYPO-RT-PCHYPO-RT-PC: seven fractions match 39
A milestone in how this cancer is treated.
What is in development for Localised prostate cancer, intermediate risk, drawn from the whole corpus: 5 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 · 4
- CHHiP · phase 3 · 2016 · positive
- HYPO-RT-PC · phase 3 · 2019 · positive
- PACE-B · phase 3 · 2024 · positive
- ProtecT · phase 3 · 2016 · completed
Open problems and what is being done
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.
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
New York · cancer center | United States | 0 | 5,100 | 94,456 | #1 | ||
Seoul · hospital | South Korea | none recorded | 0 | 464 | 3,248 | #22 | |
Stanford · university | United States | 0 | 3,000 | 50,162 | #30 | ||
Shanghai · hospital | China | none recorded | 0 | 2,872 | 31,534 | - | |
Sydney · cancer center | Australia | none recorded | 0 | 2,222 | 33,278 | - | |
Beijing · hospital | China | none recorded | 0 | 1,784 | 18,230 | - | |
Dallas, TX · cancer center | United States | 0 | 1,744 | 19,757 | - | ||
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Guangzhou · hospital | China | none recorded | 0 | 1,245 | 12,931 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Hangzhou · cancer center | China | none recorded | 0 | 1,219 | 17,635 | - | |
Beijing · hospital | China | none recorded | 0 | 1,154 | 11,808 | - | |
Rozzano (Milan) · hospital | Italy | none recorded | 0 | 1,031 | 10,720 | - | |
Changsha · cancer center | China | none recorded | 0 | 930 | 14,477 | - | |
Jinan · cancer center | China | none recorded | 0 | 920 | 7,804 | - |
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, intermediate 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, intermediate 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 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), 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 Favourable intermediate risk, Unfavourable intermediate risk, Localised acinar adenocarcinoma, Grade Group 2 or 3.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Favourable intermediate risk
- For my situation (favourable intermediate risk), which of the standard options do you recommend and why?Why: Guideline options include: Radical prostatectomy, external beam radiotherapy (moderate or ultra-hypofractionated) or brachytherapy alone; active surveillance for selected men with low volume Grade Group 2 disease.
- How do the results of CHHiP and PACE-B apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Unfavourable intermediate risk
- For my situation (unfavourable intermediate risk), which of the standard options do you recommend and why?Why: Guideline options include: 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.
- Am I a candidate for Leuprolide (leuprorelin) and GnRH agonists, 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.
Deciding on hormone therapy
- For my situation (deciding on hormone therapy), which of the standard options do you recommend and why?Why: Guideline options include: ArteraAI Prostate predicts benefit from short-course androgen deprivation with radiotherapy; Decipher stratifies risk.
- Am I a candidate for ArteraAI Prostate, Decipher Prostate, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of ArteraAI Prostate, Decipher Prostate, SBRT / SABR (stereotactic radiotherapy)?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 “Whether favourable intermediate risk can be safely watched in the long term”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “How to select men for hormone therapy without giving it to everyone in the unfavourable group”. 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, intermediate 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
11targets
1drugs
3companies
6terms
1trials
4Latest papers
topQuery for this cancer: (TITLE:"Localised prostate cancer, intermediate risk" OR ABSTRACT:"Localised prostate cancer, intermediate risk" OR TITLE:"Intermediate-risk prostate cancer" OR ABSTRACT:"Intermediate-risk prostate cancer" OR TITLE:"Favourable intermediate risk" OR ABSTRACT:"Favourable intermediate risk" OR TITLE:"Unfavourable intermediate risk" OR ABSTRACT:"Unfavourable intermediate risk" OR TITLE:"Grade Group 2 and 3 prostate cancer" OR ABSTRACT:"Grade Group 2 and 3 prostate cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Localised prostate cancer, intermediate risk, not a curated reading list.
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