A 65-year-old man is diagnosed with prostate cancer with a Gleason score of 4+4=8 (Grade Group 4), PSA 18 ng/mL, clinical stage cT2b, and no evidence of metastasis. According to D'Amico risk classification, what risk category is this, and what is the standard treatment recommendation?
- A Intermediate risk; active surveillance
- B High risk; definitive local therapy (radical prostatectomy or radiotherapy) with androgen deprivation therapy ✓
- C Intermediate risk; radical prostatectomy or radiotherapy
- D Very high risk; androgen deprivation therapy alone
Correct answer: B. High risk; definitive local therapy (radical prostatectomy or radiotherapy) with androgen deprivation therapy
Explanation
D'Amico high-risk prostate cancer is defined by any one of: PSA >20 ng/mL, Gleason score ≥8 (Grade Group 4-5), or clinical stage ≥T3a. This patient has Gleason 8 (Grade Group 4), meeting high-risk criteria. Standard management for high-risk localized prostate cancer includes definitive local therapy — either radical prostatectomy (with bilateral pelvic lymph node dissection) or external beam radiotherapy — combined with long-term androgen deprivation therapy (ADT) for 2-3 years. Active surveillance is not appropriate for high-risk disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.