## Analysis of Prostate Cancer Management Statements ### Statement-by-Statement Review **Statement 1 (Active Surveillance) — TRUE** **Key Point:** Active surveillance is the standard of care for low-risk prostate cancer (Gleason ≤6, PSA <10 ng/mL, clinical stage ≤T2a) with life expectancy >10–15 years [cite:Harrison 21e Ch 182]. - Reduces overtreatment and associated morbidity (erectile dysfunction, incontinence). - Deferred treatment does not compromise survival in carefully selected cohorts. **Statement 2 (Radical Prostatectomy vs EBRT) — NOT TRUE** **High-Yield:** There is **no definitive evidence** that radical prostatectomy offers superior oncological outcomes compared to external beam radiotherapy (EBRT) in intermediate-risk disease. Both modalities achieve comparable long-term biochemical recurrence-free and overall survival rates when performed by experienced teams [cite:Robbins 10e Ch 20]. - This is a common exam trap: students often assume surgery is "better" than radiation. - The choice depends on patient age, comorbidity, functional status, and preference. - ~~Prostatectomy is always superior~~ — this is incorrect. **Statement 3 (ADT + EBRT in High-Risk Disease) — TRUE** **Key Point:** Combined androgen deprivation therapy (2–3 years) + external beam radiotherapy improves overall survival in high-risk localized prostate cancer (Gleason ≥8, PSA >20 ng/mL, or stage ≥T3) [cite:Harrison 21e Ch 182]. - Landmark trials (RTOG 9202, EORTC 22991) demonstrated 10-year OS benefit. **Statement 4 (PSA Velocity) — TRUE** **Clinical Pearl:** PSA velocity >4 ng/mL/year is an independent predictor of prostate cancer mortality in untreated men, even after adjusting for baseline PSA and Gleason score [cite:Park 26e Ch 9]. - Rapid PSA rise suggests aggressive biology. - Used in risk stratification for active surveillance cohorts. ### Summary Table | Statement | Correctness | Rationale | |-----------|-------------|----------| | Active surveillance in low-risk | TRUE | Standard of care; reduces overtreatment | | RP superior to EBRT in intermediate-risk | **FALSE** | No definitive superiority; comparable outcomes | | ADT + EBRT improves OS in high-risk | TRUE | Level 1 evidence from RCTs | | PSA velocity >4 ng/mL/yr predicts mortality | TRUE | Independent prognostic factor | **Answer: Statement 2 is NOT true.**
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