TABLE 4.

Initial Treatment Recommendations for Intermediate- and High-risk Local Prostate Cancer^8,14,35

Organization	Intermediate Risk	High Risk
AUA/ASTRO/SUO	Favorable or unfavorable: RP or RT + ADT	RP or RT + ADT
EAU	RP if life expectancy >10 y, only as part of multimodal therapy ePLND if estimated metastatic risk >5% EBRT + ADT (4–6 months) with low-dose brachytherapy boost	RP if life expectancy >10 y, only as part of multimodal therapy ePLND EBRT + long-term ADT (2–3 y)
NCCN	Favorable	Unfavorable	If life expectancy >5 y or symptomatic: EBRT + ADT (1.5–3 y) EBRT + brachytherapy + ADT (1–3 y) RP + PLND: If adverse features without LN metastases: EBRT ± ADT (6 mo) or observation If LN metastasis: ADT ± EBRT, or observation
	If life expectancy >10y: Active surveillance EBRT or brachytherapy alone RP ± PLND if predicted probability of LN metastases ≥2%: Adverse features without LN metastases: EBRT ± ADT (6 mo) or observation LN metastasis: ADT ±EBRT, or observation	Life expectancy >10y: RP ± PLND if predicted probability of LN metastases 2%: Adverse features without LN metastases: EBRT ± ADT (6 mo) or observation LN metastases: ADT (category 1) ± EBRT, or observation EBRT ± ADT (4 mo)
	If life expectancy <10 y: Observation (preferred) EBRT or brachytherapy alone	Life expectancy <10 y: Observation (preferred) EBRT + brachytherapy ± ADT (4 mo)

ADT, androgen deprivation therapy; ASTRO, American Society for Radiation Oncology; AUA, American Urological Association; EAU, European Association of Urology; EBRT, external beam radiotherapy; ePLND, extended pelvic lymph node dissection; LN, lymph node; NCCN, National Comprehensive Cancer Network; RP, radical prostatectomy; RT, radiotherapy; SUO, Society of Urologic Oncology.