Loading
10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
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.
| Setting | Approach | Guideline |
|---|---|---|
| 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. | not mapped |
| 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. | not mapped |
| Deciding on hormone therapy | ArteraAI Prostate predicts benefit from short-course androgen deprivation with radiotherapy; Decipher stratifies risk. | not mapped |