<p><strong> </strong><strong>For patients with unfavorable intermediate- or high-risk prostate cancer and estimated life expectancy greater than 10 years, clinicians should offer a choice between radical prostatectomy or radiation therapy plus ADT. <em>(Strong Recommendation; Evidence Level: Grade A)</em></strong></p>
Discussion
Discussion
<p>For patients with unfavorable intermediate- or high-risk clinically localized prostate cancer, definitive local therapy is advised.<sup>148-151</sup> The optimal treatment for these patients remains a topic of active study, and prior published meta-analyses have reported relatively disparate findings as to comparative survival following each of these treatment approaches.<sup>152, 153</sup><sup> </sup>The Panel supports offering patients with unfavorable intermediate- and high-risk disease either radical prostatectomy or radiation with ADT (see Principles of Surgery and Principles of Radiation). For patients with sufficiently high-risk disease (clinically node positive, or with 2 of 3 of the following criteria: clinical stage T3 or T4, PSA ³ 40 ng/mL, or ³ Gleason 8), treatment with radiation and ADT can include two years of concurrent abiraterone acetate plus prednisone as well.<sup>154</sup></p>