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How would you approach a patient with Gleason 9 prostate cancer and regional lymphadenopathy as well as inguinal lymphadenopathy (M1a) but no bone metastases?
Would you offer definitive management with radiation and ADT? Or systemic therapy alone such as with ADT+abiraterone?
Answer from: Radiation Oncologist at Academic Institution
Definitely warrants a balanced discussion. Systemic therapy as the mainstay is definitely the right answer--long-term ADT for sure, at minimum. I think offering to treat the prostate with RT is fair, based on STAMPEDE. For a fit patient with good life expectancy, I would explain to the patient that ...
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Answer from: Medical Oncologist at Community Practice
I think this patient has stated above fits the high-risk category in the STAMPEDE trial. Although not a significant survival advantage but close to it and very impressive freedom from progression. Therefore, I would treat the prostate with radiation and add ADT with abiraterone. I think they did not...