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PROSCA 2019 - case 6

Your case challenge (patient with oligometastatic PCa)

Jérome was trained in the French Navy to sail submarines, but had to quit because of claustrophobia. He spent the rest of his career as the captain of a Seine River Cruise. Two years ago, at age 69, Jérome underwent radical prostatectomy for pT2b pN0 cM0 PCa, with negative margins, but ISUP 4. His first postoperative PSA was negative. Today, he visits you to discuss a follow-up assessment:

  • Asymptomatic
  • PSA: 2.0 ng/ml (6 months before: 1.2 ng/ml)
  • PSA-DT: 8 months
  • Bone scan and CT scan negative, but PSMA PET/CT: uptake in right acetabulum and positive on biopsy
  • Otherwise fit
  • No relevant comorbidities

Which option would you suggest to Jérome?