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Initial management of regionally localized intermediate, high, and very high-risk prostate cancer

John F Ward, MD, FACS
Nicholas Vogelzang, MD
Brian Davis, MD, PhD
Section Editors
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD


Prostate cancer is increasingly diagnosed in younger men and at an earlier disease stage [1,2]. However, some men with newly diagnosed prostate cancer have more extensive disease (clinical stage T2b or higher), regional lymph node metastases (N1), or other factors associated with an increased risk of local recurrence or progression to disseminated disease (serum prostate specific antigen [PSA] >10 ng/mL or Gleason score 7 or higher) (table 1A-B and table 2) [1]. (See "Prostate cancer: Risk stratification and choice of initial treatment".)

This topic discusses the initial management approach for men with prostate cancer at increased risk for recurrence and dissemination. The approaches to the treatment of men with low-risk prostate cancer and for those with distant metastases are discussed separately. The management of patients who are managed with radical prostatectomy and are considered at increased risk following pathologic staging is also discussed separately.

(See "Initial approach to low- and very low-risk clinically localized prostate cancer".)

(See "Overview of the treatment of disseminated prostate cancer".)

(See "Prostate cancer: Pathologic stage T3 disease or positive surgical margins following radical prostatectomy".)


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Literature review current through: Sep 2016. | This topic last updated: Oct 6, 2016.
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