Alfred (60 years old)

Alfred, a 60-year-old animal chiropractor, has dedicated his life to easing the pain of furry patients. From adjusting the spine of a majestic horse to soothing the aches of a playful puppy, he's seen it all. But when he's not busy cracking backs, he indulges in his guilty pleasure: binge-watching adorable animal videos online. 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: cT3a
Prostate biopsy: ISUP grade group 3 (Gleason score 4+3)
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?

RP + ePLND

Neoadjuvant ADT + RP + ePLND

Neoadjuvant ARPI + RP + ePLND

EBRT + brachytherapy boost + long-term ADT (≥1.5 years)

EBRT + long-term ADT (≥1.5 years)

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