Prostate Nodule Smart Manager · Assessment, Follow-up & Treatment Decision — free guideline decision tool

This tool combines PI-RADS, PSA density, and DRE for biopsy/follow-up triage, then after diagnosis gives NCCN risk stratification and active-surveillance/surgery/radiotherapy + ADT/chemotherapy principles.

PI-RADS + PSAD (threshold 0.15) → biopsy decision. ISUP grade + PSA band + cT → NCCN risk group (low/favorable-int/unfavorable-int/high/very-high) → surveillance vs RP vs EBRT + ADT, with chemotherapy/ARPI for advanced disease.

Use to decide biopsy versus follow-up (1–2 mostly follow-up, 3 by PSAD, 4–5 biopsy) and, once ISUP/stage are known, to stratify risk and outline treatment.

Metastatic first-line therapy combines ADT early with an ARPI or docetaxel rather than using ADT alone. (original synthesis · not guideline verbatim) PSAD < 0.15 with a negative DRE supports deferring biopsy at PI-RADS 1–3. Diagnosis relies on biopsy pathology, and the simplified risk stratification must integrate core involvement, PSAD, and genomics.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: PI-RADS v2.1 category (mpMRI) 1, Serum PSA 6.5 ng/mL, Prostate volume (for PSAD) 50 mL, Digital rectal exam DRE No nodule palpated, ISUP/grade group (if biopsied) Not biopsied/unknown, Clinical stage cT (if diagnosed) Unknown → Result: Conclusion PI-RADS 1 · follow-up（(1) Assessment & biopsy decision: PI-RADS 1: low probability of clinically significant cancer (csPCa). (PSAD ≈ 0.130 ng/mL/cc) PSAD < 0.15 and DRE negative → may defer biopsy, follow with PSA/MRI., Note: If biopsy-confirmed, entering ISUP grade, PSA, and clinical stage can continue to give risk stratification, surgery, and radiotherapy/chemotherapy principles., Basis: PI-RADS v2.1 (ACR/ESUR 2019) + PSAD 0.15 consensus; NCCN prostate cancer v2.2025; EAU guideline; CSCO prostate cancer guideline.） Inputs: PI-RADS v2.1 category (mpMRI) 5, Serum PSA 6.5 ng/mL, Prostate volume (for PSAD) 50 mL, Digital rectal exam DRE Suspicious nodule palpated, ISUP/grade group (if biopsied) 5 (Gleason 9–10), Clinical stage cT (if diagnosed) T3b–T4 → Result: Conclusion PI-RADS 5 · diagnosed treatment decision（(1) Assessment & biopsy decision: PI-RADS 5: biopsy strongly recommended (targeted + systematic). (PSAD ≈ 0.130 ng/mL/cc), (2) Risk stratification: ISUP grade 5 / PSA < 10 / clinical stage t3b_t4 → NCCN very high risk., (3) Management strategy & surgery: Multimodal: EBRT + long-course ADT (± abiraterone), or RP + extended PLND + adjuvant therapy. Needs full staging (PSMA-PET/bone scan) to exclude metastasis. Surgical procedure: radical prostatectomy (robotic/laparoscopic preferred), with PLND extent and nerve-sparing decided by risk.）