During routine screening, a 65-year-old man was found to have a PSA level of 4ng/mL, increased from 0.4ng/mL the year prior. Biopsy demonstrated a Gleason 4+4 adenocarcinoma of the prostate. He underwent a radical prostatectomy, with the identification of a Gleason 4+4 (with a tertiary component of 5) adenocarcinoma, involving 65% of the prostate gland with extraprostatic extension, extensive perineural invasion, and seminal vesicle involvement, but with negative margins; 0/12 lymph nodes were positive for prostate cancer (pT3b, pN0).
The patient’s postoperative PSA level reached a nadir of 0.2ng/mL, which subsequently increased to 2.4ng/mL within 6 months of the surgery. He was started on androgen deprivation therapy (ADT) with an LHRH agonist and an antiandrogen. His PSA level has now risen to 7.9ng/mL.
His testosterone level is 27ng/dL after 8 months of combined androgen blockade therapy. Bone scan demonstrates new bone lesions. The patient also has an ECOG PS 1, and the pain is currently being controlled with acetaminophen.
Which of the following interventions is most appropriate for this patient?
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