Adamo (71 years old)

Adamo, an active 71-year-old volunteer for Animal Welfare, presents for a routine check-up at his general practitioner and is found to have an irregular prostate on digital rectal examination.

Asymptomatic
No relevant comorbidities
PSA: 25 ng/ml
Biopsy: ISUP grade 3 [Gleason score 4+3], 6/12 cores are positive
Clinical stage: cT3a
Bone scan: spot in left iliac bone and S1 spinal vertebrae
CT scan: no other metastases

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

ADT alone

ADT + docetaxel

ADT + AR-targeted therapy

ADT + RT to prostate

ADT + RT to prostate + stereotactic RT to bone lesions

ADT + systemic treatment + RT to prostate + stereotactic RT to bone lesions