Prostate cancer (US version)
High-risk non-metastatic prostate cancer

Milo (77 years old)

Milo is a very fit 77-year-old former swimmer, who now enjoys living close to the sea and snorkeling almost every day.

He was recently diagnosed with PCa.

Assessment summary:

  • Medical history: no relevant comorbidities or medication
  • PSA: 22 ng/ml
  • ECOG PS: 0
  • Serum testosterone: 150 ng/dl
  • Clinical stage: T3a
  • Prostate biopsy: ISUP grade group 4 [Gleason score: 4 + 4]
  • Bone scan: no sign of bone metastases
  • Pelvic MRI: confirmation of an extracapsular extension, suspicious right external iliac lymph node
  • Choline PET/CT: hypermetabolic right external iliac node corresponding to the suspicious pelvic MRI node. No other signs of node involvement or distant metastases

Which of the following treatment options would you choose for this patient?