Localized Prostate Cancer · Surveillance vs Prostatectomy vs Radiotherapy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] NCCN risk stratification + life expectancy
   Risk stratification (PSA/Gleason/stage) + life expectancy?
   • Very-low/low-risk (and life expectancy >10 years) → Active surveillance
   • Intermediate (favorable/unfavorable) → Intermediate → prostatectomy or radiotherapy
   • High-risk/locally advanced → High-risk → prostatectomy ± adjuvant or radiotherapy + long ADT
   • Short life expectancy/elderly, low-intermediate risk → Elderly → watchful waiting
2. [End] Active surveillance
   Active surveillance — very-low/low-risk (and some favorable intermediate): PSA + multiparametric MRI + repeat biopsy follow-up; proceed to definitive treatment on progression (grade/volume increase).
3. [End] Intermediate → prostatectomy or radiotherapy
   Intermediate → radical prostatectomy (± pelvic lymph node dissection) or radiotherapy (EBRT/brachytherapy) ± short-course ADT (unfavorable); choose by life expectancy and preference.
4. [End] High-risk → prostatectomy ± adjuvant or radiotherapy + long ADT
   High-risk/locally advanced → radical prostatectomy + pelvic lymph node dissection ± adjuvant therapy, or radiotherapy + long-course ADT (± abiraterone); multidisciplinary.
5. [End] Elderly → watchful waiting
   Short life expectancy/elderly → watchful waiting (symptom-driven palliation); distinct from active surveillance (the latter aims for cure).

Source guidelines & references

• Localized prostate cancer management (NCCN risk stratification; AUA/EAU)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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