The first 60 days: 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. Below, week by week, is what OnCo's record of Localised prostate cancer, intermediate risk says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- PathologistNamed in the standard of care for: Favourable intermediate risk, Deciding on hormone therapy.
- SurgeonNamed in the standard of care for: Favourable intermediate risk, Unfavourable intermediate risk, Deciding on hormone therapy.
- Medical oncologistNamed in the standard of care for: Favourable intermediate risk, Unfavourable intermediate risk, Deciding on hormone therapy.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Favourable intermediate risk, Unfavourable intermediate risk, Deciding on hormone therapy.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
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.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?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?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?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?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?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?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?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?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?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?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?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)?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?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?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?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?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Localised prostate cancer, intermediate risk: the full pageIntermediate-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.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Gleason score / Grade Group: The pathologist's 1-to-5 grade of how abnormal prostate cancer looks, which drives most treatment decisions.
Every term links to the glossary.