A 68-year-old man with newly diagnosed prostate cancer has PSA 18 ng/mL, Gleason score 4+3=7 (Grade Group 3), and clinical stage T2b. He has no metastases on bone scan. According to the D'Amico risk stratification, which category does he belong to?
- A Low risk
- B Intermediate risk
- C High risk ✓
- D Very high risk
Explanation
D'Amico high-risk prostate cancer is defined by any one of: PSA >20 ng/mL, Gleason score ≥8 (Grade Group 4-5), or clinical stage T3a. This patient has PSA 18 (borderline but below 20) and Gleason 4+3=7 (Grade Group 3) with T2b — which falls into intermediate-favorable or unfavorable intermediate. However, per modern NCCN classification, a Gleason score with primary pattern 4 (4+3) with PSA 18 and T2b qualifies as unfavorable intermediate. Strictly by D'Amico original criteria with PSA <20, Gleason 7, T2b: this is intermediate risk; if any single D'Amico high-risk criterion is met, it is high risk. Reassessing: T2b (≤T2c), PSA 18 (<20), Gleason 4+3=7 — none meets D'Amico high-risk cutoff individually, placing him in intermediate risk. The correct answer is B.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.