Case 6: José

José, 69 years old, has relapsed with metachronous mHSPC.

• Medical history:
  • 5 years ago: radical prostatectomy for T2N0M0 PCa, ISUP grade group 4 (Gleason score 4+4)
  • 4 years ago: early prostate bed salvage RT without ADT for biochemical recurrence (PSA: 0.31 ng/ml)

José was lost to follow-up as he had moved across the country, and presents again today:

• ECOG PS: 0
• Symptoms: back and hip pain, fatigue
• PSA: 11 ng/ml
• CT and bone scan
  • Multiple lymph nodes in pelvic, para-aortic and mediastinal areas
  • 14 bone metastases (5 on pelvis, 4 on spine, 4 on multiple ribs bilateral, 1 on right femur)
  • No sign of visceral metastasis
• No actionable germline or somatic mutations detected
• He will start treatment with ADT

José desires to maintain his independence, and his day-to-day quality of life is his top priority.