A 70-year-old man has a PSA of 18 ng/mL. Systematic and targeted MRI-guided biopsy (TRUS/MRI fusion) shows Gleason Grade Group 4 (Gleason 4+4=8) prostate cancer in 6/12 cores, clinical stage T2cN0M0. He is fit for curative treatment. Which treatment option offers equivalent oncological outcomes to radical prostatectomy?
- A Active surveillance
- B Brachytherapy (LDR seeds) alone
- C External beam radiotherapy (EBRT) with long-term ADT ✓
- D High-intensity focused ultrasound (HIFU)
Explanation
For high-risk localised prostate cancer (Grade Group 4-5, T2c, PSA >20), both radical prostatectomy and external beam radiotherapy combined with long-term androgen deprivation therapy (2-3 years) offer equivalent oncological outcomes (cancer-specific survival, biochemical recurrence rates) based on multiple randomised trials and observational data. Active surveillance is not appropriate for high-risk disease. LDR brachytherapy monotherapy is not recommended for high-risk disease but can be combined with EBRT. HIFU is experimental and not a standard curative option for 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.