Intermediate risk prostate cancers have typically grown big enough for a doctor to feel on a physical exam and see on an imaging test.

Prostate cancer is one of the most common cancers in males. It begins in the prostate gland, which produces seminal fluid (part of semen).

To better understand the likelihood of tumor growth (progression), doctors and researchers categorize prostate cancers that have not yet spread beyond the gland into different risk groups:

  • very low risk of progression
  • low risk of progression
  • intermediate risk of progression
  • high risk of progression
  • very high risk of progression

This article focuses on intermediate risk prostate cancer. We’ll discuss the criteria for this condition; its types, diagnosis, treatment, and outlook; and other important topics.

Intermediate risk prostate cancers are usually those that have grown big enough for a doctor to feel on a physical exam and see on an imaging test.

Additional criteria for intermediate risk prostate cancer describe how much the cancer has spread and how advanced it is. Doctors often use the American Joint Committee on Cancer’s TNM scale to describe these characteristics in different types of cancer.

The main factors that make up the TNM scale for prostate cancers are:

  • Prostate-specific antigen (PSA) level: A high level of this protein in your blood is associated with an increased risk of prostate cancer progression.
  • Gleason prostate cancer score: This metric is a sum of two numbers that describe how prominent cancer cells are in your prostate (the first number) and how aggressively they grow (the second number).
  • Grade Group: This metric is a newer alternative to the Gleason score.

Your tumor will be classified as intermediate risk prostate cancer if:

  • it’s in more than half of one side of your prostate (stage cT2b) or
  • it’s in both sides of your prostate (stage cT2c) or
  • your PSA level is 10–20 nanograms per milliliter (ng/mL) of blood or
  • your tumor has a Grade Group of 2–3 or a Gleason score of 7 (3+4 or 4+3)

Doctors further separate intermediate risk prostate cancers into two types to help them choose the correct course of treatment. The two types are favorable and unfavorable intermediate risk prostate cancer.

Favorable intermediate risk prostate cancer

Cancers of this type typically have a lower risk of spreading beyond the prostate gland.

Specific metrics that describe favorable intermediate risk prostate cancer include:

  • Grade Group 2
  • Gleason score 3+4

Unfavorable intermediate risk prostate cancer

This type usually indicates a higher risk of cancer spreading beyond the prostate gland.

Scores that describe this type include:

  • Grade Group 3
  • Gleason score 4+3

The levels of PSA are similar between the two groups.

To diagnose prostate cancer and determine its risk group, a doctor will first perform a physical exam and take your medical history. As part of the physical, they will likely do a digital rectal exam. During this exam, a doctor will insert a gloved, lubricated finger into your anus and feel for any unusual growths or masses.

After the physical, they will likely order a few lab tests:

Your doctor will diagnose intermediate risk prostate cancer if the results of your PSA blood test and prostate biopsy fall within the expected range for this risk group.

Treatment options for intermediate risk prostate cancer vary depending on several factors, such as:

  • favorable vs. unfavorable group
  • your age and overall health
  • your preferences

In some cases (usually, if you have favorable intermediate risk prostate cancer), doctors may recommend “watchful waiting.” This approach involves closely monitoring the cancer with regular checkups, PSA tests, and biopsies while delaying treatment until necessary. However, recent research suggests that early treatment has benefits over watchful waiting.

If your intermediate risk prostate cancer does need treatment, your doctor may recommend the following:

Your outlook will depend on:

  • your age
  • your overall health
  • the cancer type
  • the cancer stage (the size of the tumor) and risk group (how quickly it’s expected to grow)

Generally, favorable intermediate risk prostate cancer has a higher survival rate than unfavorable intermediate risk cancer. Still, be sure to discuss your individual outlook with your urologist or oncologist, as it can vary based on your situation.

According to the American Cancer Society, the average 5-year relative survival rate for prostate cancers that haven’t yet spread (such as intermediate risk prostate cancer) is more than 99%.

What is a 5-year survival rate?

Health professionals often use 5-year survival rate as a measure of a disease’s outlook. It refers to the percentage of people with the disease who are still alive at least 5 years after their diagnosis.

Another commonly used term is “5-year relative survival rate.” This is a measure of how many people with the disease are alive 5 years later compared with people without the disease.

Was this helpful?

Let’s go over a few questions that people with intermediate risk prostate cancer frequently ask their doctors.

What does intermediate risk of cancer mean?

Intermediate risk prostate cancers are more aggressive than low risk cancers and less aggressive than high risk cancers. They have a Gleason score of 7 (Grade Group 2 or 3) and PSA levels of less than 20 ng/mL.

How fast does intermediate prostate cancer spread?

Intermediate risk prostate cancers are in stage cT2b or cT2c, which means they have not yet spread beyond the prostate. However, they can spread more slowly (favorable) or more quickly (unfavorable).

What is favorable intermediate risk prostate cancer?

Favorable intermediate risk prostate cancers belong to Grade Group 2 (Gleason score 3+4). They are expected to spread more slowly than unfavorable intermediate risk prostate cancers and sometimes don’t need active treatment.

What is unfavorable intermediate risk prostate cancer?

Unfavorable intermediate risk prostate cancers belong to Grade Group 3 (Gleason score 4+3). They usually spread more quickly and typically need treatment right away.

Intermediate risk prostate cancer falls between low risk and high risk prostate cancer in terms of aggressiveness. Favorable intermediate risk cancer has a lower chance of spreading and may need only watchful waiting instead of active treatment. Unfavorable intermediate risk cancer usually requires immediate treatment.

Survival rates for intermediate risk prostate cancer are usually quite high. Still, they depend on many factors. Be sure to speak with your doctor about your individual outlook.