Prostate cancer

Topic: Biochemical recurrence after radical prostatectomy

Case 1: Ferdinand (69 years old)

Ferdinand, 69 years, used to be a furniture finisher. He had surgery for intermediate-risk PCa 8 years ago (biopsy ISUP grade 1[Gleason score 3+3]; PSA: 12.4 ng/mL). Pathological findings: pT2a, pathological ISUP grade 2 [Gleason score 3+4], negative surgical margins. Postoperatively his PSA was undetectable, but now it’s slowly increasing.
 
Recent diagnostic work-up
  • PSA: 0.22 ng/mL (first measurable PSA 18 months ago: 0.08 ng/mL)
  • PSA doubling time: 10 months
Comorbidities: Ferdinand was diagnosed with multidrug-resistant tuberculosis 2 months ago. He experiences many adverse events from the drugs and the infection is difficult to control. He feels rather frail. This brings his life expectancy below 5 years.

Which option do you consider most appropriate in this patient?