How would you treat a patient with Gleason 8 or 9 prostate cancer, pretreatment PSA 15-24, with retroperitoneal adenopathy?

I would offer a similar approach to that described nicely by @Dr. First Last and @Dr. First Last: definitive RT+ADT+abiraterone, with SIB to the grossly positive nodes. My caveats and additions are:

1. I start with a frank discussion with the patient re: evidence for various scenarios and general prog...

Patient meets STAMPEDE criteria (about 9% with non regional nodal Mets) and optimal ADT with prostate only RT is also an option especially if nodal burden is to the entire paraaortic region.

I would typically use a curative-intent paradigm with ADT + Abiraterone, plus prostate-directed radiotherapy with a radiotherapy boost (if possible) to the pelvic and RP nodes. If PSA remains undetectable after 2 years of systemic therapy, I would consider stopping the ADT + Abi and watching careful...

I don’t see the logic in treating only the prostate when u have similar disease in the node. If u radiate, radiate all gross disease area if it can be encompassed in a reasonable volume. With the same dose to gross disease as prostrate, do ADT and arbiter one for 2 to 3 yrs and then follow and go ba...