A 70-year-old man is diagnosed with localised high-risk prostate cancer: PSA 22 ng/mL, Gleason score 4+4=8 (Grade Group 4), clinical stage T2cN0M0. He has no significant comorbidities. The current EAU/NCCN guideline-recommended management for high-risk localised prostate cancer is:
- A Radical prostatectomy with extended pelvic lymph node dissection or external beam radiotherapy with long-term androgen deprivation therapy (2-3 years) ✓
- B External beam radiotherapy alone
- C Brachytherapy monotherapy
- D Androgen deprivation therapy alone
Explanation
EAU 2023 guidelines recommend two equivalent curative options for high-risk localised prostate cancer: (1) Radical prostatectomy with extended pelvic lymph node dissection (ePLND), or (2) External beam radiotherapy (EBRT) combined with long-term androgen deprivation therapy (ADT) for 2-3 years. The DART01/05 GICOR, EORTC 22863, and RTOG 86-10/92-02 trials established ADT addition to EBRT as improving OS. Brachytherapy monotherapy is used for low-intermediate risk. ADT alone is palliative, not curative. Both RP+ePLND and EBRT+ADT have equivalent oncologic outcomes allowing patient preference to guide selection.
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.