Prostate cancer
Adverse pathology at radical prostatectomy

Gary (69 years old)

Gary is a 69-year-old retired violinist. He was recently diagnosed with high-risk prostate cancer (PCa; PSA 32.2 ng/mL, cT2b, biopsy ISUP grade 3 (Gleason score [GS] 7 [4+3]), organ confined according to MRI). He was treated with radical prostatectomy (RP) and an extended pelvic lymph node dissection (ePLND). The pathology report shows:

 

  • An upgrading from biopsy ISUP grade 3 [GS 7] to pathological ISUP grade 4 [GS 8]

  • Positive surgical margins (SM+)

  • Seminal vesicle invasion (SVI)

  • Extracapsular extension (ECE)/pT3

  • No positive lymph nodes (pN0)

Which of the following options do you consider most appropriate for this patient?