Prostate cancer
High-risk non-metastatic prostate cancer

Liam (63 years old)

Liam, a 63-year-old storm hunter, lives for the thrill of the chase. While others seek shelter during tornado warnings, he runs toward them to capture Mother Nature's fury. But sometimes, he wonders if he's chasing storms or running from something within himself. He was diagnosed with PCa during a check-up.

Assessment summary:

  • Medical history: no relevant comorbidities or medication
  • ECOG PS: 0
  • PSA: 19 ng/ml
  • Clinical stage (DRE): cT3a
  • mpMRI: PI-RADS 5 lesion left apical-mid peripheral zone, extracapsular extension, prostate volume 44 ml, no bulky median lobe
  • Prostate biopsy: ISUP grade group 4 (Gleason score 4+4)
  • CT (abdomen/pelvis) + bone scan, or PSMA-PET/CT: no signs of positive LNs or distant metastasis

Which of the following treatment options would you choose as a next step for this patient?