TiSBU Urologia Practice Questions - TiSBU - Título De Especialista Em Urologia (Sociedade Brasileira De Urologia AMB) Exam

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A 58-year-old asymptomatic man with a life expectancy >15 years is diagnosed with localized prostate cancer following an elevated PSA of 4.6 ng/mL. A 12-core systematic biopsy reveals ISUP Grade Group 1 (Gleason 3+3=6) adenocarcinoma in 1 core (involving 15% of the core). Pre-biopsy mpMRI showed a 7 mm PI-RADS 3 lesion in the left peripheral zone, and DRE is normal (cT1c). According to major consensus guidelines (such as PRIAS and SBU guidelines), what is the most appropriate initial management strategy?

Immediate radical prostatectomy with bilateral extended pelvic lymphadenectomy. Active surveillance with serial PSA monitoring, periodic clinical/mpMRI evaluation, and confirmatory/surveillance biopsies. External beam radiation therapy with 24 months of androgen deprivation therapy (ADT). Immediate bilateral subcapsular orchiectomy.

Correct Answer:

Active surveillance with serial PSA monitoring, periodic clinical/mpMRI evaluation, and confirmatory/surveillance biopsies.

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