A 68-year-old man with a PSA of 8.2 ng/mL and a prostate MRI showing a PI-RADS 4 lesion in the peripheral zone (apex) undergoes MRI-targeted biopsy. Histology reveals Gleason score 3+4=7 (Grade Group 2) in 2 of 3 targeted cores. According to EAU 2023 guidelines, the preferred management is:
- A Radical prostatectomy or radical radiotherapy as curative intent ✓
- B Active surveillance with repeat biopsy in 12 months
- C Androgen deprivation therapy (ADT) alone for 2 years
- D Watchful waiting given age over 65
Explanation
EAU 2023 guidelines risk-stratify prostate cancer. Gleason 3+4=7 (Grade Group 2) with PSA 8.2 ng/mL is intermediate-risk prostate cancer. For intermediate-risk localized prostate cancer, the standard of care is curative-intent therapy: radical prostatectomy (open, laparoscopic, or robotic) or radical radiotherapy (EBRT ± brachytherapy boost) with short-term ADT (6 months). Active surveillance is appropriate for very low-risk (GG1) and selected low-risk (GG1-2) patients with favorable features, but GG2 with 2/3 positive targeted cores is generally considered for treatment. ADT monotherapy is palliative, not curative. Watchful waiting is for men with limited life expectancy.
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.