What Does Intermediate-Risk Prostate Cancer Mean?

If you’ve been diagnosed with prostate cancer, you may have been told that your cancer is “intermediate-risk” prostate cancer. About half of people with prostate cancer have intermediate-risk cancer. But what does that actually mean? 

Prostate cancer isn’t just one disease — there are different types. Prostate cancers are grouped according to how likely they are to spread. A low-risk prostate cancer is unlikely to spread outside the prostate or cause serious illness. A high-risk prostate cancer can cause serious illness. An intermediate-risk prostate cancer is somewhere in between. 

But why is your cancer intermediate risk? And what does that mean for your treatment? If you’ve been diagnosed with intermediate-risk prostate cancer, here’s what you need to know. 

What determines if prostate cancer is ‘intermediate-risk’? 

There are several pieces of information that are used to determine if a prostate cancer is low, intermediate, or high risk. Prostate cancer staging is based on:

• Prostate-specific antigen (PSA) level

• Size of the tumor 

• Tumor spread beyond the outer layer of the prostate

• How many core samples from the prostate biopsy have cancer cells in them

• The tumor grade group or Gleason score (what the prostate cancer cells look like under the microscope)

Favorable vs. unfavorable intermediate-risk prostate cancer

A large number of prostate cancers fall into the intermediate-risk category. That’s why intermediate-risk prostate cancer is further divided into two subgroups: “favorable intermediate risk” and “unfavorable intermediate risk.” These subgroups help you and your team understand how your cancer is likely to behave long term. 

The difference between “favorable intermediate risk” and “unfavorable intermediate risk” often depends on your prostate biopsy results. 

 “Favorable intermediate risk” means:

• Your cancer has a Gleason grade group of 1 or 2.

• Less than half of your prostate biopsy samples showed cancer cells.

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“Unfavorable intermediate risk” means:

• Your cancer has a Gleason grade group of 2 or 3.

• More than half of your prostate biopsy samples showed cancer cells.

Your oncology team will also use your PSA levels and other test results to make this determination.

What tests can diagnose prostate cancer?

A prostate biopsy is the main tool for diagnosing prostate cancer. During a biopsy, a small amount of tissue is removed for examination under a microscope. This is how the Gleason score is determined. 

Your healthcare team may recommend additional tests to learn more about how your cancer might behave. Not everyone needs these tests, but they may be helpful in some cases: 

• Genetic testing: People with a history of cancer in their families may benefit from genetic testing of their prostate cancer.  

• Molecular testing: Molecular tests like Oncotype DX, Prolaris, ConfirmMD, ArteraAI, and Decipher can give clues on how your tumor is likely to behave. Your team can use these results to recommend treatment options. 

• Prostate MRI: Your team might recommend a prostate MRI. An MRI can make it easier to determine the size of your tumor and plan a prostate biopsy.

• Imaging studies: If you have unfavorable intermediate-risk prostate cancer, your team might recommend a bone scan or other imaging studies, like PSMA PET/CT, to make sure your cancer hasn’t traveled outside your prostate.  

How are intermediate-risk prostate cancers treated? 

Some people with intermediate-risk prostate cancer can be treated with active surveillance. But many people need other kinds of treatment. Let’s take a look at possible intermediate-risk prostate cancer treatments.

Radiation therapy

Radiation therapy uses beams of energy (radiation) to destroy cancer cells. There are two main ways that radiation therapy can be given: external beam radiation therapy (EBRT) and brachytherapy. With EBRT, the radiation is administered by a machine. For this treatment, you go to a radiology oncology center and lie on a table while a machine passes over you and administers the radiation. Typically, this is done daily over a period of several weeks. 

Brachytherapy is a type of internal radiation. In low-dose brachytherapy and high-dose brachytherapy, small radioactive pellets (called seeds) are placed inside your body. Once the seeds are placed, they emit radiation continuously over time. The seeds are removed after high-dose brachytherapy. The seeds don’t need to be removed if you receive low-dose brachytherapy. 

Surgery

Some people choose to have their entire prostate removed, which also removes the cancer cells. This is called a radical prostatectomy. Surgery is invasive and also comes with potential side effects. 

Androgen deprivation therapy

Androgen deprivation therapy is an option for people with unfavorable intermediate-risk prostate cancer. It’s used with radiation therapy.

Active surveillance 

With active surveillance, you’ll have testing done at regular intervals. This includes prostate biopsies, blood tests, imaging, and exams. If your cancer changes, you would need to start a new treatment plan. Active surveillance is only an option for some people with favorable intermediate-risk prostate cancer. It’s not a treatment option if you have unfavorable intermediate-risk prostate cancer. 

Observation

Choosing observation means that you’ll check yourself for symptoms. If you notice any new symptoms, you would let your healthcare team know. At that point, you would need new tests. Observation is usually only recommended for people who are older or not likely to live more than 10 years. 

Which treatment for intermediate-risk prostate cancer is best? 

The best treatment for prostate cancer depends on your cancer’s characteristics, but it also depends on you. Every person’s situation is unique, and what might be the best treatment for one person might not be the best treatment for you. 

Some of the factors that may help you and your team decide on a treatment plan include the following.

Your age 

The older you are, the less likely it is that your prostate cancer will have time to grow and spread. If you’re older, you may consider less-invasive treatment options. 

Other health concerns

You may have health conditions that make one treatment option more risky than another. You’ll need to work with your team to balance the risks and benefits of your treatment options against your overall health needs. 

Your preferences 

It’s up to you and your healthcare team to balance the risks and benefits of each treatment option and make the choice that’s right for you. Your thoughts about treatment may change over time — that’s normal. Keep talking with your healthcare team so that the plan can change with you. 

Frequently asked questions 

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Written by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Brandon R. Mancini, MD, MBA, FACRO

Brandon R. Mancini, MD, MBA, FACRO, serves as medical director at BAMF Health in Grand Rapids, Michigan in the emerging field of theranostics. His primary clinical focus is on the treatment of people with metastatic prostate and neuroendocrine cancers.

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