Prostate cancer

Topic: Adverse pathology at radical prostatectomy

Case 1: Larry (69 years old)

Larry is a 69 years old retrired police officer. He enjoys long walks in nature in his free time. 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). Larry 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]
  • Negative surgical margins (SM-)
  • No seminal vesicle invasion (SVI)
  • No extracapsular extension (ECE)/pT3
  • No positive lymph nodes (pN0)
After RP, PSA was undetectable. Larry is otherwise healthy and has no co-morbidities.

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