A 68-year-old man with PSA 12 ng/mL undergoes transrectal ultrasound-guided biopsy showing Gleason 4+3 = 7 (Grade Group 3) prostate cancer, confined to the prostate (cT2c). He is fit for surgery. According to current risk stratification, he is categorised as which risk group and what is the recommended primary treatment approach?
- A Intermediate-unfavourable (or high-risk) — radical prostatectomy or radiotherapy with androgen deprivation therapy ✓
- B Low risk — active surveillance is appropriate
- C Intermediate-favourable risk — active surveillance or radical treatment
- D High risk — ADT monotherapy alone is the standard treatment
Correct answer: A. Intermediate-unfavourable (or high-risk) — radical prostatectomy or radiotherapy with androgen deprivation therapy
Explanation
Gleason 4+3 = 7 (Grade Group 3, where the pattern 4 is predominant) with PSA 12 ng/mL classifies this as intermediate-unfavourable or borderline high-risk disease. Active surveillance is inappropriate as Gleason 4+3 carries significantly greater risk of progression than 3+4. Standard treatment options include radical prostatectomy (with extended pelvic lymph node dissection) or external beam radiotherapy combined with androgen deprivation therapy (ADT) for 4–6 months minimum. ADT monotherapy is not appropriate for non-metastatic disease as it is not curative.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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