A 65-year-old man has a PSA of 18 ng/mL and a Gleason score 8 (4+4) prostate adenocarcinoma on biopsy. PSMA PET-CT shows no distant metastases. He is clinically T2cN0M0. Which STAMPEDE trial–based approach best improves overall survival in this high-risk localized setting?

• A Radical prostatectomy alone
• B External beam radiotherapy alone
• C Long-term androgen deprivation therapy (ADT) combined with docetaxel
• D Long-term ADT combined with radical radiotherapy plus docetaxel ✓

Explanation

The STAMPEDE trial demonstrated that for high-risk localized prostate cancer, adding docetaxel to long-term ADT + radiotherapy significantly improves failure-free survival compared to radiotherapy + ADT alone. Abiraterone was also shown to improve outcomes. The combination of ADT, radiotherapy, and docetaxel represents the most intensified systemic approach shown to improve survival in high-risk non-metastatic disease based on STAMPEDE data. Radiotherapy alone or surgery alone is insufficient for Gleason 8+ high-risk disease.

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.