Raphael (77 years old)

Raphael, a very fit 77-year-old retired plumber, spends his days tending to his garden. One day he noticed a neighbour struggling with a malfunctioning sprinkler system. With a twinkle in his eye, he grabbed his tools and rushed over, unleashing his decades of plumbing expertise. Unfortunately, he was recently diagnosed with PCa.

Assessment summary:

• Medical history: no relevant comorbidities or medication
• ECOG PS: 0
• Geriatric-8 (G8) score: 15/17
• PSA: 22 ng/ml
• Clinical stage (DRE): cT3a
• mpMRI: confirmation extracapsular extension, suspicious right external iliac LN
• Prostate biopsy: ISUP grade group 4 (Gleason score 4+4)
• CT (abdomen/pelvis) + bone scan, or PSMA-PET/CT: enlarged and hypermetabolic right external iliac node (corresponding to MRI). No other signs of node involvement or bone or distant metastasis