A 67-year-old man has newly diagnosed prostate adenocarcinoma. Multiparametric MRI demonstrates extracapsular extension consistent with cT3a disease;

Question

A 67-year-old man has newly diagnosed prostate adenocarcinoma. Multiparametric MRI demonstrates extracapsular extension consistent with cT3a disease; there is no seminal-vesicle invasion. Targeted biopsy shows Gleason score 4+3=7 (grade group 3) disease. PSA is 18 micrograms/L. CT and isotope bone scan show no nodal or distant metastases. He is fit for curative treatment and, after counselling, chooses radical external beam radiotherapy rather than prostatectomy. Using the Roach formula, his estimated risk of pelvic lymph-node involvement is 22%. What is the most appropriate MDT treatment recommendation?

Accepted Answer

Hypofractionated radical external beam radiotherapy with 6 months of androgen-deprivation therapy; consider pelvic radiotherapy and continuing androgen-deprivation therapy for up to 3 years.

Answer

Androgen-deprivation therapy alone for 3 years; defer radical radiotherapy unless he develops biochemical or radiological progression.

Answer

Hypofractionated radical external beam radiotherapy with 3 years of androgen-deprivation therapy; omit pelvic radiotherapy and present this duration as mandatory.

Answer

Hypofractionated radical external beam radiotherapy with 6 months of androgen-deprivation therapy; omit pelvic radiotherapy and stop androgen-deprivation therapy at 6 months.

Answer

Brachytherapy alone with 6 months of androgen-deprivation therapy; consider pelvic radiotherapy if the PSA subsequently rises.

CPG4 locally advanced non-metastatic prostate adenocarcinoma — MSRA MCQ