Radical prostatectomy is a primary treatment option for unfavorable intermediate-risk prostate cancer, offering curative potential through complete surgical removal of the prostate and, when indicated, pelvic lymph node dissection. 

Surgery allows for precise pathological staging, helping guide further treatment decisions. In some cases, if adverse features like positive margins or extraprostatic extension are found, adjuvant or salvage radiation therapy may be recommended postoperatively. Radical prostatectomy is most appropriate for younger, healthier patients who are candidates for surgery and prefer a one-time, definitive treatment. While it provides excellent long-term control, potential side effects include urinary incontinence, erectile dysfunction, and the risks associated with major surgery.