A 55-year-old man is found to have a serum PSA of 12 ng/mL on routine screening. Digital rectal examination reveals a hard nodule in the right lobe of the prostate. Transrectal ultrasound-guided biopsy shows adenocarcinoma with a Gleason score of 3+4=7 in 4 of 12 cores. Bone scan and CT pelvis show no evidence of metastatic disease. His life expectancy is more than 10 years. What is the most appropriate management?

• A Radical prostatectomy or radical radiotherapy with curative intent ✓
• B Active surveillance with PSA monitoring alone
• C Androgen deprivation therapy alone
• D Watchful waiting without intervention

Explanation

Gleason 3+4=7 (Grade Group 2) localised prostate cancer in a fit patient with greater than 10 years life expectancy represents intermediate-risk disease that warrants curative-intent treatment: either radical prostatectomy or radical external beam radiotherapy (with or without short-course androgen deprivation). Active surveillance is appropriate for very low/low-risk disease (Gleason ≤6, PSA <10), not for intermediate-risk. Androgen deprivation therapy alone is palliative and does not offer cure. Watchful waiting is reserved for men with limited life expectancy who would not tolerate or benefit from treatment.

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.