A 65-year-old man presents with lower urinary tract symptoms (hesitancy, poor stream, nocturia). DRE reveals a hard, irregular, fixed prostate. PSA is 45 ng/mL. Prostate biopsy shows Gleason score 4+4=8 adenocarcinoma. Bone scan shows multiple metastases. The most appropriate treatment is:

• A Radical prostatectomy
• B External beam radiotherapy
• C Brachytherapy
• D Androgen deprivation therapy (LHRH agonist) ✓

Explanation

Metastatic prostate cancer (M1) is not curable by surgery or radiotherapy; systemic androgen deprivation therapy (ADT) using LHRH agonists (e.g., goserelin, leuprolide) or bilateral orchidectomy is the cornerstone of treatment, as prostate cancer is testosterone-dependent. Radical prostatectomy is reserved for localised disease. Brachytherapy is used for low-to-intermediate risk localised disease. External beam radiotherapy can treat localised or locally advanced disease but is not the primary modality for bone-metastatic disease.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.