Hugh (69 years old)

Hugh, a 69-year-old retired architect, spends his mornings sketching the intricate details of the historic buildings in his town. His keen eye for design have earned him recognition among his peers. He was referred to a urologist because of an episode of acute urinary retention. He was diagnosed with very high-risk PCa during further work-up.

Assessment summary:

• Medical history: controlled hypertension (on 2 antihypertensives)
• ECOG PS: 1
• PSA: 43 ng/ml
• Clinical stage (DRE): cT3
• mpMRI: cT3b cN0, prostate volume 48 ml
• Biopsy: ISUP grade group 4 (Gleason score 5+3)
• CT (abdomen/pelvis) + bone scan, or PSMA-PET/CT: no signs of positive LNs or distant metastasis