Case 3: Rui

Rui, 69 years old, has a history of PCa.

Medical history:

• Diagnosed with high-volume mHSPC 1 year ago
  • PSA: 63 ng/ml
  • Bone and CT scan: multiple bone metastases
  • Treatment with ADT + docetaxel + darolutamide was started
  • After 6 cycles of docetaxel, his PSA dropped to 2 ng/ml
• Current situation, 6 months after stopping docetaxel, treatment with darolutamide is still ongoing:
  • No comorbidities
  • No relevant family history
  • ECOG PS: 0
  • Asymptomatic
  • Rising PSA: 13 ng/ml
  • Testosterone: 17 ng/dl (0.6 nmol/L)
  • Bone and CT scan: 3 new bone metastases, not present on scans 6 months ago, few enlarged pelvic lymph nodes (all <3 cm)
  • PSMA-PET/CT: concordant with bone and CT scan, all lesions PSMA positive and higher PSMA expression than liver
  • No actionable germline or somatic mutations detected