Clinically Localized Prostate Cancer: Introduction, Risk Assessment, Staging and Risk-Based Management

Publication Date: May 10, 2022

Risk Assessment

Clinicians should use clinical T stage, serum PSA, Grade Group (Gleason score), and tumor volume on biopsy to risk stratify patients with newly diagnosed prostate cancer. (Strong, B)

Clinicians may selectively use tissue-based genomic biomarkers when added risk stratification may alter clinical decision-making. (Expert Opinion, )

Clinicians should not routinely use tissue-based genomic biomarkers for risk stratification or clinical decision-making. (Moderate, B)

Clinicians should perform an assessment of patient and tumor risk factors to guide the decision to offer germline testing that includes mutations known to be associated with aggressive prostate cancer and/or known to have implications for treatment. (Expert Opinion, )


Clinicians should not routinely perform abdomino-pelvic computed tomography (CT) scan or bone scan in asymptomatic patients with low- or intermediate-risk prostate cancer. (Expert Opinion, )

Clinicians should obtain a bone scan and either pelvic multi-parametric magnetic resonance imaging (mpMRI) or CT scan for patients with high-risk prostate cancer. (Strong, B)

In patients with prostate cancer at high risk for metastatic disease with negative conventional imaging, clinicians may obtain molecular imaging to evaluate for metastases. (Expert Opinion, )

Risk-Based Management

Clinicians should inform patients that all prostate cancer treatments carry risk. The risks of treatment, in particular to patients’ urinary, sexual, and bowel function, must be incorporated with the risk posed by the cancer, patient life expectancy, comorbidities, pre-existing medical conditions, and patient preferences to facilitate a shared decisionmaking approach to management. (Clinical Principle, )

Clinicians should provide an individualized risk estimate of post-treatment prostate cancer recurrence to patients with prostate cancer. (Clinical Principle, )

For patients with low-risk prostate cancer, clinicians should recommend active surveillance as the preferred management option. (Strong, A)

In asymptomatic patients with prostate cancer and limited life expectancy (determined on a patient-specific basis), clinicians should recommend watchful waiting. (Strong, A)

For patients with favorable intermediate-risk prostate cancer, clinicians should discuss active surveillance, radiation therapy, and radical prostatectomy. (Strong, A)

Clinicians should inform patients with intermediate-risk prostate cancer considering whole gland or focal ablation that there are a lack of high-quality data comparing ablation outcomes to radiation therapy, surgery, and active surveillance. (Expert Opinion, )

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. (Strong, A)

Clinicians should not recommend whole gland or focal ablation for patients with highrisk prostate cancer outside of a clinical trial. (Expert Opinion, )

Clinicians may recommend palliative ADT alone for patients with high-risk prostate cancer, local symptoms, and limited life expectancy. (Expert Opinion, )

Recommendation Grading


  • ADT: Androgen Deprivation Therapy
  • ASCO: American Society Of Clinical Oncology
  • ASTRO: American Society For Radiation Oncology
  • AUA: American Urologic Association
  • CT: Computed Tomography
  • DRE: Digital Rectal Examination
  • NGI: Next Generation Imaging
  • PDT: Photodynamic Therapy
  • PSA: Prostate-specific Antigen
  • PSMA: Prostate-specific Membrane Antigen
  • QOL: Quality Of Life
  • SDM: Shared Decision-making
  • mpMRI: Multi-parametric Magnetic Resonance Imaging




Clinically Localized Prostate Cancer: Introduction, Risk Assessment, Staging and Risk-Based Management

Authoring Organizations

Publication Month/Year

May 10, 2022

Supplemental Implementation Tools

Document Type


Country of Publication


Document Objectives

The summary presented herein represents Part I of the three-part series dedicated to Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, discussing risk assessment, staging, and risk-based management in patients diagnosed with clinically localized prostate cancer. Please refer to Parts II and III for discussion of principles of active surveillance, surgery and follow-up (Part II), and principles of radiation and future directions (Part III). 

This guideline aims to inform clinicians treating patients with clinically localized prostate cancer. Continued research and publication of high-quality evidence from future trials will be essential to further improve care for these men.

Target Patient Population

Patients with clinically localized prostate cancer

Target Provider Population

Urologists, radiation oncologists, medical oncologists and other allied providers caring for patients with prostate cancer

Inclusion Criteria

Male, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient, Radiology services

Intended Users

Radiology technologist, nurse, nurse practitioner, physician, physician assistant


Diagnosis, Assessment and screening, Management

Diseases/Conditions (MeSH)

D011467 - Prostate, D011471 - Prostatic Neoplasms


prostate cancer, cancer staging, localized prostate cancer

Source Citation

Eastham JA, Auffenberg GB, Barocas DA, Chou R, Crispino T, Davis JW, Eggener S, Horwitz EM, Kane CJ, Kirkby E, Lin DW, McBride SM, Morgans AK, Pierorazio PM, Rodrigues G, Wong WW, Boorjian SA. Clinically Localized Prostate Cancer: AUA/ASTRO Guideline, Part I: Introduction, Risk Assessment, Staging and Risk-Based Management. J Urol. 2022 May 10:101097JU0000000000002757. doi: 10.1097/JU.0000000000002757. Epub ahead of print. PMID: 35536144.

Supplemental Methodology Resources

Data Supplement


Number of Source Documents
Literature Search Start Date
August 1, 2021
Literature Search End Date
September 1, 2021