What's the best treatment for intermediate-risk prostate cancer?

Thank you for sharing your diagnosis and the thoughtful questions about treatment options. Making decisions about intermediate-risk prostate cancer treatment can feel overwhelming, and connecting with others who have walked this path is a valuable step. The factors that influence treatment decisions often include age, overall health, cancer characteristics, personal values about quality of life, and individual risk tolerance. Many community members have found it helpful to discuss their priorities with their medical team and to seek second opinions when needed. This community has members with experience across all the treatment options mentioned, and their shared experiences often provide insights about recovery timelines, managing side effects, and navigating the emotional aspects of treatment decisions.

Daniel, I'm sorry you have to go through this but it's here and now you have to deal with it. First of all, your biggest fear will be "fear of the unknown ". You will get through this believe me. If you can find others that have gone through it that's always a huge help. My situation was intermediate risk with a Gleason score of 7. My decision process was difficult but I had to do something per my urologist. I chose to do the prostatectomy versus radiation. My thoughts were I want it out and take all the cells with it. Everything went well until the 3rd psa test and it had risen slightly ( from .043 to .080). My urologist suggested I do 34 radiation treatments and Orgovyx (hormone treatment for 6 months) I didn't have the ProTon option. The hormone medication was annoying with hot flashes but manageable. I have since had psa tests and have dropped to .018. It has been a two year process so be patient. God has been with me every step of the way and I know I will fulfill all the days of my life. Have faith and know you got this. Prayers for you/family and your decision.

Dear Daniel G — What you must urgently do is read every comment by every commenter regarding PCa that you find anywhere on O4M. Spoiler alert: If you read all comments by everyone, you will choose active surveillance. That’s what I would have done, but I didn’t know anything about )4M when I had to decide, and I mistakenly believed my so-called “care” team would fully disclose the benefits and costs of every possible procedure. That was before I discovered that the medicos will barely mention—if at all—the downsides of recommended procedures. After all, they make their living with these procedures; they make nothing from active surveillance. My treatments—EBRT and ADT—caused 29 complications, essentially destroying my urinary, bowel, and sexual functioning. I am now 2 years and 2 months post-treatment and have all the original complications plus three more that developed so far in 2026. Stay strong, get info, and trust your own judgement.

I’m waiting to get TULSA Procedure.

Dear Daniel, I was told in November 2024 after getting a Biopsy that I had prostate cancer. I was told that I had options and decided on Radiation because the Dr told me there were no side effects. However I found out at the Cancer Center that was not true. They wanted me to get hormone treatments and Radiation. 28 days in a row. I needed to have a bowel movement every day before the treatments and drink a bottle of water. I decided not to do that. I then went to a surgeon for robotics removal and was told I was too old at 76 to have it done. I decided on active surveillance and will not seek treatments until and if it spreads to other body parts. I should tell you that I have no problems that an enlarged prostate would cause. I hope this helps in your decision.

Daniel, there are many possible new focal therapies to investigate. I had Gleason 3+4 all on the left side with an intermediate risk Decipher score. I chose AS and at my one year biopsy there was not much growth. My PSA was usually under 4. I had planned another year of AS until my decipher score came back as high risk. That changed everything for me. Next week I undergo IRE (Nanoknife) which will blast it with electricity. There are a number of these newer focal therapies such as IRE, Tulsa, Hifu, and others. IRE seemed best for me and my circumstances. Their success rates are all similar - higher chance of reoccurrence but less side effects versus surgery or radiation. If it does return, your salvage options are all on the table. But you have to be willing to actively participate in surveillance. Hope this helps.

Me recent High risk, deemed contained with targeted biopsy at UCLA and PSMA. GLEASON 8s and one 9. UCLA surgeon conference for prostectomy. Wanted to go the proton beem route. All sold on it until Dr said 18 to 24 months of hormone therapy. ADT. So I studied what that was all about. After reading about bone loss, muscle loss, libido gone, erection s gone, hot flashes, male breasts. I have another retired brilliant urologist i conference with since she has no skin in the game.. She tested my urine output which nobody else did. .Formulated questions to ask both Proton dr s and UCLA surgeon for me. Proton guy comes back and says,. OH WITH that urine output you need a turp first, then hormone concurrently 18 to 24 months ADT with Proton been for 24 days. UCLA surgeon comes back with prostectomy, no hormones, better flow after. It was a no brainer after that. Surgery in 2 days. It was an easy choice since I maybe getting rid of the. cancer and NO HORMONE THERAPY!!!

Mike, Good luck!! I have a friend who did prostectomy. He has some minor issues, which are to be expected, but generally very happy with his decision.

Dan, like some others here - I too had the option of surgery or radiation. It is a personal choice which way to go depending on one's lifestyle and overall health condition. My Gleason score was just under the need for hormone therapy so I (based on all of the above) chose radiation (5 consecutive sessions of 1 hour each, but there are other options of shorter sessions [15 minutes] throughout 46 days). Exercise and a good diet is key with either decision of surgery or radiation. Lastly, discussing with my family and healthcare team was also key. And a mental health provider is also a good idea given all the emotions one has to navigate. Hope this helps your decision; wishing you many blessings and a positive outcome.

Dan, I too had the option of surgery or radiation. It is a personal choice which way to go depending on one's lifestyle and overall health condition. My Gleason score was just under the need for hormone therapy so I (based on all of the above) chose radiation (5 consecutive sessions of 1 hour each, but there are other options of shorter sessions [15 minutes] throughout 46 days). Exercise and a good diet is key with either decision of surgery or radiation. Lastly, discussing with my family and healthcare team was also key. And a mental health provider is also a good idea given all the emotions one has to navigate. Hope this helps your decision; wishing you many blessings and a positive outcome.

Dan, I too had the option of surgery or radiation. It is a personal choice which way to go depending on one's lifestyle and overall health condition. My Gleason score was just under the need for hormone therapy so I (based on all of the above) chose radiation (5 consecutive sessions of 1 hour each, but there are other options of shorter sessions [15 minutes] throughout 46 days). Exercise and a good diet is key with either decision of surgery or radiation. Lastly, discussing with my family and healthcare team was also key. And a mental health provider is also a good idea given all the emotions one has to navigate. Hope this helps your decision; wishing you many blessings and a positive outcome.