A 65-year-old man has a PSA of 12 ng/mL and a multiparametric MRI showing a PI-RADS 4 lesion in the left peripheral zone. Systematic plus targeted transperineal biopsy shows Gleason 4+3=7 (Grade Group 3) in 4/14 cores, all from the target lesion. Clinical stage is T2c N0 M0. He has a 15-year life expectancy. The recommended initial management is:

• A Active surveillance
• B Androgen deprivation therapy alone
• C Focal HIFU therapy
• D Radical prostatectomy or radical radiotherapy (with androgen deprivation) ✓

Explanation

Gleason 4+3 = Grade Group 3 localised prostate cancer in a 65-year-old with good life expectancy is intermediate-unfavourable risk disease. Current EAU/AUA guidelines recommend curative-intent treatment — radical prostatectomy or external beam radiotherapy with short-course ADT. Active surveillance is not appropriate for Grade Group 3 with a 15-year life expectancy due to the risk of metastatic progression.

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.