A 65-year-old man has PSA 12 ng/mL and multiparametric MRI (mpMRI) shows a PI-RADS 4 lesion in the right peripheral zone. Targeted MRI-fusion biopsy confirms Gleason score 4+3=7 (Grade Group 3) in 3 of 12 cores. His clinical T stage is T2c. According to the NCCN risk stratification, he is classified as:

• A Intermediate risk — unfavorable ✓
• B Low risk
• C Intermediate risk — favorable
• D High risk

Explanation

NCCN classifies prostate cancer intermediate risk as either favorable (1 intermediate factor: Grade Group 1–2, PSA 10–20, or T2b) or unfavorable (≥2 intermediate risk factors, or Grade Group 3, or ≥50% positive biopsy cores). This patient has Grade Group 3 (Gleason 4+3), which alone places him in the unfavorable intermediate risk category regardless of other factors. High risk requires GG ≥4, PSA >20, or T3+. Management for unfavorable intermediate: radical prostatectomy or external beam RT + 4–6 months ADT.

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.