A 68-year-old man has a PSA of 12 ng/mL with a Gleason score 4+3=7 (Grade Group 3) prostate cancer in 4 of 12 cores. The lesion is organ-confined on MRI. According to the EAU risk stratification, this is classified as which risk group and what treatment is preferred?
- A Intermediate risk — unfavourable; radical prostatectomy or external beam radiotherapy with short-term ADT (6 months) ✓
- B Low risk; active surveillance preferred
- C High risk; external beam radiotherapy with long-term ADT (2–3 years)
- D Very low risk; watchful waiting only
Correct answer: A. Intermediate risk — unfavourable; radical prostatectomy or external beam radiotherapy with short-term ADT (6 months)
Explanation
EAU intermediate-risk prostate cancer is subdivided into favourable (GG1–2, one risk factor) and unfavourable (GG3 or ≥2 intermediate features). A Gleason 4+3 = Grade Group 3 with PSA 12 ng/mL and ≥4 positive cores is unfavourable intermediate risk. Management options include radical prostatectomy (with extended pelvic lymph node dissection if PLND risk >5%) or EBRT plus 4–6 months of ADT. Active surveillance is not appropriate for GG3 disease. Long-term ADT (>18 months) is reserved for high-risk disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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