Prostate cancer
Oligometastatic PCa: treating the primary and/or metastases

Alphonso (80 years old)

Alphonso, 80 years old with a G8 score 15/17* and ECOG PS 0 was diagnosed with metastatic PCa (multiple bone metastases and extra-pelvic lymph nodes). He was treated with ADT. Abiraterone was added when he became castrate-resistant.

  • PSA response at 1 year: reduction from 45 ng/ml to 1.3 ng/ml

After 18 months of treatment, the PSA begins to rise.

  • PSA: 3.0 ng/ml
  • PSA-DT: 5 months
  • PSMA-PET/CT: oligoprogression in 2 extra-pelvic lymph nodes (para-aortic), other lesions stable/partial response
  • Asymptomatic

*G8 (Geriatric 8) screening tool; healthy patients with a G8 score >14 should receive the same treatment as younger patients according to EAU guidelines

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