Prostate Cancer

A 62-year-old man presents with lower urinary tract symptoms and elevated PSA of 8.5 ng/mL. Digital rectal examination reveals a hard, irregular nodule in the prostate. Which investigation is the gold standard for confirming the diagnosis of prostate cancer?

According to the Gleason grading system, which two grades are added together to determine the Gleason score in prostate cancer?

A 68-year-old man presents with lower urinary tract symptoms (LUTS) of 6 months' duration. Digital rectal examination reveals a hard, irregular prostate with loss of the median sulcus. PSA is 12 ng/mL (normal <4). Transrectal ultrasound-guided prostate biopsy shows adenocarcinoma with a Gleason score of 8 (4+4). Staging workup including pelvic MRI and bone scan shows no evidence of metastatic disease. What is the most appropriate next step in management?

A 72-year-old man with a history of hypertension and diabetes mellitus presents with bone pain in the lumbar spine and pelvis for 3 weeks. PSA is markedly elevated at 145 ng/mL. Serum alkaline phosphatase is 89 U/L (normal 30–120). Bone scan shows multiple hot spots in the lumbar vertebrae, pelvis, and femur. Biopsy of a pelvic lesion confirms adenocarcinoma of the prostate. Serum testosterone is 450 ng/dL (normal 300–1000). What is the most appropriate first-line hormonal agent for this patient?

A 68-year-old man with biopsy-proven prostate cancer (Gleason 8, PSA 45 ng/mL) is being staged for treatment planning. Which investigation is most appropriate to assess for distant skeletal metastases?