High Risk Prostate Cancer

Authored by Tyler Seibert, published on 2026-03-30 23:59:03.0

Based on NCCN risk groups, Tyler Seibert, MD, PhD, Genitourinary Section Chief, UC San Diego Radiation Oncology outlines his general recommendations for patients with high risk prostate cancer (HR PCa).

  1. NCCN high risk
    • GG1
      • Careful workup to either diagnose higher-grade disease or confirm high PSA explained by large prostate
        • Confirmed GG1, no concerning features
          • Consider AS
    • GG ≥3
      • RT + ltADT
        • ADT x18-24 months
      • RP
        • Close attention to post-RP surveillance. Consider stADT if secondary (post-op) RT needed
    • GG2 non-cribriform
      • Careful workup to either diagnose higher-grade disease or confirm high PSA explained by large prostate
        • Confirmed GG2, no concerning features
          • RT+stADT Or RP
tosprivacyEAU Prostate Cancer GuidelinesAUA/ASTRO Guideline on Clinically Localized Prostate CancerDefinition and Validation of “Favorable High-Risk Prostate Cancer”: Implications for Personalizing Treatment of Radiation-Managed PatientsEAU Prostate Cancer Diagnostic EvaluationLong-Term Outcomes in Patients Using Protocol-Directed Active Surveillance for Prostate CancerDuration of Androgen Deprivation Therapy in High-risk Prostate Cancer: A Randomized Phase III TrialAUA/ASTRO/SUO Guideline on Salvage Therapy for Prostate CancerAdjuvant or early salvage radiotherapy for the treatment of localised and locally advanced prostate cancer: a prospectively planned systematic review and meta-analysis of aggregate dataIntraductal Carcinoma and Cribriform Pattern in Prostate Cancer: Challenges and Emerging Perspectives