Unfavorable Intermediate Risk Prostate Cancer

Authored by Tyler Seibert, published on 2026-03-30 22:17:20.0

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

  1. NCCN unfavorable intermediate risk
    • GG1
      • AS (See FIR)
    • GG2 cribriform (including IDC)
      • RT + stADT
        • Decipher
          • If cost not prohibitive, patient confident they can be reliable with PO medication, and especially if patient has high risk of cardiac issues
            • Relugolix x6 months
          • Most patients
            • Leuprolide x6 months
          • If borderline case for stADT or older patient
            • Leuprolide x4 months
      • RP
        • Close attention to post-RP surveillance. Consider stADT if secondary (post-op) RT needed
    • GG3
      • RT + stADT
        • Decipher
          • If cost not prohibitive, patient confident they can be reliable with PO medication, and especially if patient has high risk of cardiac issues
            • Relugolix x6 months
          • Most patients
            • Leuprolide x6 months
          • If borderline case for stADT or older patient
            • Leuprolide x4 months
      • RP
        • Close attention to post-RP surveillance. Consider stADT if secondary (post-op) RT needed
    • GG2 non- cribriform
      • Assess risk, patient risk tolerance, comorbidities
        • Decipher
          • RT +/- ADT x4 months
          • RP
tosprivacyNCCN Prostate Cancer GuidelinesAdding Short-Term Androgen Deprivation Therapy to Radiation Therapy in Men With Localized Prostate Cancer: Long-Term Update of the NRG/RTOG 9408 Randomized Clinical TrialPreoperative PSA Velocity and the Risk of Death from Prostate Cancer after Radical ProstatectomyProstate-Specific Antigen Nadir Postradiotherapy in Localized Prostate Cancer: Is It Prognostic or Predictive?Association of Androgen Deprivation Therapy With Cardiovascular Death in Patients With Prostate Cancer A Meta-analysis of Randomized TrialsAdding Short-Term Androgen Deprivation Therapy to Radiation Therapy in Men With Localized Prostate Cancer: Long-Term Update of the NRG/RTOG 9408 Randomized Clinical TrialOral Relugolix for Androgen-Deprivation Therapy in Advanced Prostate Cancer