A 68-year-old man with a PSA of 14 ng/mL and a Gleason score 4+3=7 (Grade Group 3) prostate cancer confined to the prostate. His MRI shows organ-confined disease with no extracapsular extension. He is medically fit. The treatment option with the lowest risk of urinary incontinence while maintaining equivalent oncological control is:

• A Radical prostatectomy (nerve-sparing)
• B Brachytherapy alone (low-dose rate)
• C Active surveillance
• D External beam radiotherapy (EBRT) with short-course androgen deprivation therapy (ADT) ✓

Explanation

For intermediate-to-high risk localized prostate cancer (Gleason 4+3, Grade Group 3), EBRT with ADT provides equivalent cancer-specific survival to radical prostatectomy but is associated with significantly lower rates of urinary incontinence (radical prostatectomy: 5-20% stress incontinence vs. <5% with EBRT). EBRT carries higher rates of bowel and bladder irritative symptoms acutely, but long-term incontinence rates are substantially lower. Active surveillance is not appropriate for Grade Group 3 disease. Brachytherapy alone is generally reserved for low-to-favorable intermediate risk.

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.