title: Favorable vs Unfavorable Intermediate-Risk Prostate Cancer: A Review of the New Classification System and Its Impact on Treatment Recommendations.
abstract: The population of patients with intermediate-risk prostate cancer are a large and heterogeneous group with highly variable prognoses, which present a challenge to efforts to develop standardized treatment recommendations. New classification systems have been proposed that modify the existing National Comprehensive Cancer Network guidelines and that subdivide men with intermediate-risk prostate cancer into favorable and unfavorable subgroups. This review will examine the changing landscape of intermediate-risk prostate cancer and the effects on treatment decisions that may result from this new classification. The literature provides evidence that men with favorable intermediate-risk prostate cancer have prostate cancer-specific mortality and all-cause mortality rates similar to the rates in patients with low-risk prostate cancer and thus may be candidates for active surveillance, dose-escalated radiation therapy without short-term androgen deprivation therapy (ADT), or, interestingly, standard-dose radiation therapy plus short-term ADT. Conversely, patients with unfavorable intermediate-risk prostate cancer have prostate cancer-specific mortality and all-cause mortality rates similar to the rates in patients with high-risk prostate cancer. These patients would not be candidates for active surveillance and may in fact require long-term ADT in addition to standard-dose or dose-escalated radiation therapy instead of 4 to 6 months of ADT.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Serrano
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Anscher
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D001918:Brachytherapy / Q000379:methods; D000066491:Clinical Decision-Making / Q000379:methods*; D006801:Humans; D008297:Male; D054539:Medication Therapy Management; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment; D013223:Statistics as Topic; D016019:Survival Analysis
chemical_list: D000726:Androgen Antagonists