A 70-year-old man has a PSA of 8.2 ng/mL. TRUS-guided 12-core biopsy reveals Gleason 3+4=7 (Grade Group 2) in 4/12 cores, maximum 35% core involvement, bilateral. Clinical stage T2b. Which active surveillance criteria does this patient FAIL to meet?

• A Age >65 years
• B PSA >10 ng/mL
• C More than 2 positive biopsy cores
• D Gleason 3+4=7 (Grade Group 2) and bilateral involvement (most AS protocols limit to Grade Group 1 or carefully selected Grade Group 2 unilateral) ✓

Explanation

Most active surveillance protocols (PRIAS, PROTECT, Epstein Johns Hopkins) originally required Grade Group 1 (Gleason ≤6) disease. Revised NICE (2019) and EAU (2023) guidelines extend AS to carefully selected Grade Group 2 (3+4) patients, but bilateral involvement with 4/12 cores and 35% maximum core involvement in a Grade Group 2 patient exceeds the volume and grade threshold for most conservative AS protocols. Grade Group 2 bilateral disease is generally managed with curative treatment (radical prostatectomy or radiotherapy) rather than AS in most centres.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.