The management of patients with intermediate-risk disease may likewise be informed in part by the ProtecT trial, as approximately one third of patients therein had intermediate- or high-risk disease.122 Of note, in the trial, active monitoring was found to be associated with an increased risk of clinical progression compared to radical prostatectomy or radiotherapy (22.9 per 1,000 person-years versus 8.9 per 1,000 person-years for radical prostatectomy and 9.0 per 1,000 person-years for radiation therapy, P<0.001). Similarly, an increased risk of metastatic disease was seen for patients managed with active monitoring (6.3 per 1,000 person-years versus 2.4 per 1,000 person-years for radical prostatectomy and 3.0 per 1,000 person-years for radiation therapy, P=0.004). Nevertheless, all-cause mortality was low in each treatment arm, and no difference was noted in prostate cancer deaths. As such, the Panel believes that, with appropriate counseling, favorable intermediate-risk patients should be offered active surveillance, radical prostatectomy, and radiation therapy. Patients with favorable intermediate-risk disease who may be considered for active surveillance include those with a low PSA density, low tumor volume, as well as a low percentage of Gleason pattern 4 disease on biopsy. The Panel does recognize the noted increased risk of disease progression with active surveillance among intermediate-risk (versus low-risk) patients, particularly those with Grade Group 2 disease,125, 139 as well as the relatively limited data on very long-term follow-up of such  patients and thereby emphasizes the importance of informed SDM. Again, patients electing active surveillance should be informed of the importance of regular cancer surveillance to avoid missing the window of curability. Further, for favorable intermediate-risk patients electing treatment with radiation, at this time, ADT should not be used. The Panel recognizes the ongoing accumulation of evidence on this topic (e.g., NRG RTOG 08-15 trial, the results of which have been presented but not yet published to date). Thus, it remains unclear at this time what the benefit for these patients will be in adding ADT to their radiation treatment. Evolving evidence will inform future practice for these patients.