A 68-year-old man has a PSA of 9.2 ng/mL. MRI-guided targeted biopsy (PIRADS 4 lesion in the peripheral zone) reveals Gleason grade group 3 (4+3=7) prostate cancer in 4 of 6 cores. Clinical staging: T2c N0 M0. According to EAU 2023 guidelines for intermediate-high risk prostate cancer, which management option offers highest cancer-specific survival at 10 years?
- A Radical prostatectomy (open or robot-assisted) + pelvic lymph node dissection ✓
- B Active surveillance with PSA every 6 months
- C External beam radiotherapy (EBRT) to prostate alone without hormonal therapy
- D Androgen deprivation therapy (ADT) alone
Explanation
Gleason grade group 3 (4+3=7) represents predominantly Gleason 4 pattern, classified as intermediate-high risk cancer. EAU guidelines recommend radical prostatectomy with extended pelvic lymph node dissection (ePLND) as the primary curative treatment for intermediate-high risk prostate cancer in men with life expectancy >10 years. Alternatively, EBRT combined with long-term ADT (2-3 years, per RTOG 92-02 and EORTC 22961 trials) is an equivalent option. Active surveillance is inappropriate for grade group 3 disease. ADT monotherapy is palliative, not curative. EBRT alone without ADT is suboptimal for intermediate-high 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.