Marco (58 years old)

Marco, 58 years old, recently moved from Spain to Belgium for an incredible job opportunity. Despite the enthusiasm for his career leap, he really misses the warm and sunny weather of his hometown. Unfortunately, he was diagnosed with PCa.

Assessment summary:

Medical history: no relevant comorbidities or medication
ECOG PS: 0
PSA: 34 ng/ml
DRE: cT3a
mpMRI: PI-RADS 5, extracapsular extension, 2 enlarged left internal iliac nodes (1.6 cm and 1.2 cm)
Prostate biopsy: ISUP grade group 5 (Gleason score 5+5)
CT (abdomen/pelvis) + bone scan, or PSMA-PET/CT: 2 positive LNs (corresponding to MRI), no distant or bone metastasis

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

ADT monotherapy

RP + ePLND

RP + ePLND + long-term ADT (≥1.5 years)

EBRT + long-term ADT (≥1.5 years)

EBRT + long-term ADT (≥1.5 years) + 2 years abiraterone

EBRT + long-term ADT (≥1.5 years) + 6 cycles docetaxel