Prostate cancer
NEW --- Management of non-metastatic castration-resistant prostate cancer

Luis (67 years old)

Luis, a 67-year-old retired vocalist has performed with leading opera companies. His musical education began with playing cello and clarinet. Nowadays he enjoys attending symphonic orchestra. He is generally healthy and was diagnosed with PCa some years ago.

Medical history:

  • 4 years ago: diagnosis of high-risk PCa (cT2b, biopsy ISUP grade 3 [Gleason score 4+3])
    • Treated with RP + ePLND (pT3aN0M0 PCa and negative surgical margins)
    • Postoperative PSA 0.03 ng/ml
  • 3 years ago: PSA 0.18 ng/ml
    • Treated with salvage EBRT, undetectable PSA
  • 2 years ago: PSA 1.30 ng/ml (N0M0 on bone scan and CT)
    • Treated with ADT, PSA 0.09 ng/ml
  • Today: PSA level 4.8 ng/ml, with a PSA-DT of 5 months (serum testosterone 18 ng/dl). The bone and CT scan were negative for metastasis.

 He is treated with rivaroxaban (lifelong) for atrial fibrillation.

Which of the following treatment options would you choose for this patient?