For a very high risk prostate cancer with relatively no elevation in PSA but no distant or nodal metastasis would you consider “neoadjuvant” ADT and chemotherapy prior to EBRT?   

This is a very challenging scenario in dealing with men who have M0 N0 but very high risk disease with a Gleason 10 (grade group 5) locally advanced tumor.  Recent data supports a very poor outcome for these low PSA high grade patients when treated with IMRT and ADT alone (Mahal BA et al Eur Ur...