Wilber Johnson,an 84-year-old retired musician of Jamaican descent,was seen by his family practice physician for urinary problems.His physician performed a digital rectal exam (DRE),which was abnormal,ordered a PSA,and referred him to a urologist.Wilber's PSA was 12 ng/ml.His transrectal prostatic biopsy was positive.The biopsy specimen determined a Gleason score of 10 and his AUA score was D2.Based on this clinical diagnostic information,what is the best surgical treatment plan for Wilber?

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PSA values greater than 10 ng/ml are highly suggestive of prostatic carcinoma.Gleason scores between 8 and 10 indicate highly aggressive tumors and are associated with a poor prognosis after surgery (Epstein,2007).An AUA score of stage D2 indicates (1)metastatic prostatic cancer with pelvic lymph node metastases or ureteral obstruction causing hydronephrosis,or both,and (2)bone,soft tissue,organ,or distant lymph node metastases.

Wilber Johnson,an 84-Year-Old Retired Musician of Jamaican Descent,was Seen by His