🔷 Prostate Nodule Smart Manager · Assessment, Follow-up & Treatment Decision
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.
Prostate Nodule Smart Manager · Assessment, Follow-up & Treatment Decision
PI-RADS v2.1 category (mpMRI)
Serum PSA (ng/mL)
Prostate volume (for PSAD) (mL)
Digital rectal exam DRE
ISUP/grade group (if biopsied)
Clinical stage cT (if diagnosed)
When to use
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.
How it works
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.
Key points
- 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.
References
- Turkbey B, et al. Prostate Imaging Reporting and Data System Version 2.1 (PI-RADS v2.1). Eur Urol 2019.
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines: Prostate Cancer.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.