This page covers the management of localised prostate cancer that meets favourable intermediate-risk criteria: ISUP grade group 2 with less than 10% pattern 4, PSA below 10 ng/mL, clinical stage ≤cT2a, and low disease extent on imaging and biopsy — in men with a life expectancy greater than 10 years.
The favourable intermediate-risk designation applies when ISUP grade group 2 disease is accompanied by low biopsy extent (limited positive cores, low cancer involvement per core), PSA below 10 ng/mL, and non-advanced clinical stage. Life expectancy greater than 10 years is central to treatment selection, as it determines whether active intervention is indicated and which modality is most appropriate.
For this population, current guidelines recognise both an observational pathway for carefully selected patients and several definitive local treatment strategies. The choice between these pathways depends on additional clinical and patient-specific factors detailed in the full protocol.
The complete algorithm — including criteria for each pathway, sequencing, and all evidence-based options — is available via the structured regimen below.
Undetectable serum PSA following definitive local treatment, an appropriate PSA nadir after radiation-based therapy, and no evidence of disease progression on imaging.