Conventional prostatic adenocarcinoma.

What should be the next treatment? How can we treat this Conventional prostatic adenocarcinoma with neuroendocrine differentiation and an extensive small cell type? He has aged alot , psa is 1.1, Intense FDG uptake noted in peripheral zone of right lobe of enlarged prostate (measures 5.0x4.3 cm); SUVmax 10.9 FDG avid bilateral external iliac, left obturator nodes; ~ 3.1x2.5 cm, SUVmax 9.5 FDG avid few bilateral hilar, subcarinal, paratracheal, prevascular nodes (largest measures 1.8x0.9 cm; SUVmax 8.5), few of them demonstrating hyperattenuation of NCCT thorax: favours the granulomatous etiology. No other significant adenopathy noted FDG avid extensive lytic and marrow lesions (few with associated soft tissue; Intraspinal extension at the level of few dorsal-lumbar vertebrae and sacrum) are noted involving axial and proximal appendicular skeleton; SUVmax 9.5. Variable FDG avid varying sized hypodense lesions in both lobes of liver; largest measures ~ 2.5x3.0 cm (segment V), SUVmax 14.5