A 68-year-old man with newly diagnosed prostate cancer (Gleason grade group 2, PSA 8 ng/mL, cT2a) undergoes active surveillance. The criteria for active surveillance initiation per international guidelines (PROTECT trial/EAU 2024) include all EXCEPT:
- A Positive bone scan for skeletal lesions with PSA >10 ng/mL ✓
- B Gleason grade group ≤2 (Gleason score ≤7 = 3+4)
- C PSA <20 ng/mL
- D Clinical stage ≤T2b
Explanation
Active surveillance is appropriate for low- to favorable-intermediate risk localized prostate cancer. The EAU 2024 criteria for active surveillance include: Gleason grade group ≤2 (score ≤7 with ≤3+4), PSA <20 ng/mL, clinical stage ≤T2b, and no more than 50% of biopsy cores positive. A positive bone scan indicating skeletal metastases (M1b disease) represents metastatic prostate cancer — this is not suitable for active surveillance and requires systemic therapy (ADT ± docetaxel or novel androgen pathway inhibitors per CHAARTED/STAMPEDE/PEACE-1 trials). Active surveillance requires PSA every 3-6 months, repeat biopsies, and MRI surveillance.
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.