Prostate cancer
CRPC: treatment in daily clinical practice

Elliot (67 years old)

Elliot, a 67-year-old retired security guard at the national bank, now devotes his time to gardening. He grows a lot of vegetables, enough to share with family and neighbours, and these are much more nutritious and tasty than those you get from the store. Otherwise a healthy man, he was diagnosed with high-risk PCa (cT2b, biopsy ISUP grade 3 [Gleason score 4+3]) and treated with RP + ePLND.

  • Pathology report: pT3aN0M0 PCa, negative surgical margins
  • Postoperative PSA: 0.03 ng/ml

1 year later, the PSA rose to 0.18 ng/ml. He was treated with salvage EBRT which resulted in an undetectable PSA.

Again 1 year later, the PSA increased to 1.30 ng/ml (N0M0 on bone scan and CT). He received ADT; PSA: 0.09 ng/ml.

However, 2 years later the PSA level increased to 4.8 ng/ml, with a PSA-DT of 5 months (serum testosterone 18 ng/dl).

  • Bone and CT scan: N0 M0 disease
  • PSMA-PET/CT scan: 1 positive bone lesion (left pedicle of L2)

Which treatment option would you choose for this patient?