Case 2026: Paul (expert opinion by T. Zilli)

Paul, 70 years old, maintains a remarkably fit lifestyle, swimming year-round and travelling frequently. He can often be found at Schiphol Airport on his way to coastal destinations across Europe to pursue his passion for sea swimming.

Following a routine health check, Paul is diagnosed with unfavourable intermediate-risk PCa.

• Medical history: no relevant comorbidities or medication
• ECOG PS: 0
• G8 score: 17/17
• PSA: 18.2 ng/ml
• ECOG PS: 0
• DRE: cT2
• mpMRI: PI-RADS 4 lesion lateral left, no extracapsular extension, prostate volume 40 ml
• Prostate biopsy: ISUP Grade Group 3 (Gleason score 4+3); 8/12 cores positive
• PSMA-PET/CT: no signs of positive lymph nodes or distant metastases

Paul indicates he wants to avoid surgery. In addition, he prefers a treatment approach that requires limited treatment management on his part and provides peace of mind while travelling.