Prostate cancer
High-risk non-metastatic prostate cancer

Frederick (61 years old)

Frederick, a 61-year-old trade unionist, recently joined a large protest to defend the farmers’ working conditions. At the end of the demonstration, he found 3 tractors blocking his car… He was recently diagnosed with PCa.

Assessment summary:

  • Medical history: no relevant comorbidities or medication
  • ECOG PS: 0
  • PSA: 17 ng/ml
  • Clinical stage (DRE): cT2b
  • mpMRI: PI-RADS 4 lesion in right mid-peripheral zone, no extracapsular extension, prostate volume 40 ml, no bulky median lobe
  • Prostate biopsy: ISUP grade group 5 (Gleason score 4+5)
  • 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?