Prostate cancer
Oligometastatic PCa: treating the primary and/or metastases

Roberto (80 years old)

Roberto, 80 years old with a G8 score 15/17* and ECOG PS 0, was diagnosed with metastatic PCa (multiple bone metastases and extra-pelvic lymph nodes). He was treated with ADT. Abiraterone was added when he became castrate-resistant.

  • PSA response at 1 year: reduction from 45 ng/ml to 1.3 ng/ml

After 18 months of treatment, the PSA begins to rise.

  • PSA: 3.0 ng/ml
  • PSA-DT: 5 months
  • PSMA-PET/CT: oligoprogression in one of the existing bone lesions on right pubic ramus, lymph nodes fully resolved
  • Slight pain over bone area (grade 1), otherwise asymptomatic from disease

*G8 (Geriatric 8) screening tool; healthy patients with a G8 score >14 should receive the same treatment as younger patients according to EAU guidelines

Which of the following options would you choose for this patient?