← All algorithms · Related notes →
This algorithm stratifies management of localized prostate cancer by risk group, covering both the choice of local therapy and the duration of androgen deprivation therapy (ADT). Low-risk disease is managed preferentially with active surveillance, monitored with PSA, MRI, and biopsy. Favorable intermediate-risk disease may also be managed with active surveillance, or with radiotherapy or radical prostatectomy.
Unfavorable intermediate-risk disease is treated with radiotherapy plus short-term ADT for 4 to 6 months, or with radical prostatectomy and pelvic lymph node dissection when indicated. High-risk and very high-risk disease is treated with radiotherapy plus long-term ADT, with or without abiraterone, or with radical prostatectomy and lymph node dissection as part of multimodal therapy. The addition of abiraterone is supported by STAMPEDE, which showed a survival benefit in high-risk and node-positive disease. The general principle on the chart is that long-term ADT should accompany radiation for high-risk disease, while active surveillance is preferred for low-risk and many favorable intermediate-risk cancers.
Background reading: Prostate cancer board review notes.
Risk-stratified local therapy and ADT duration. Starting point: Localized prostate cancer by risk group. Full background: Prostate cancer notes.
Simplified board-prep scaffold; verify against current guidelines and primary literature. Add long-term ADT to radiation for high-risk disease; abiraterone improves survival in high-risk/node-positive disease (STAMPEDE). Active surveillance is preferred for low and many favorable-intermediate cancers.