Willy (73 years old)

Willy, 73 years old, loves bird watching. He put several seed and nut feeders in his garden to attract  birds. He spends hours a day to identify the different species and to study their behaviour. He was diagnosed with PCa 7 years ago.

Medical history:

• 7 years ago: RP for PCa (pT3bN0, ISUP grade 5, postoperative PSA <0.1 ng/ml)
• 6 years ago: salvage RT for rising PSA (0.53 ng/ml)
• 5 years ago: ADT started because of rising PSA (7 ng/ml), no metastases on conventional imaging
• 2 years ago: progression to mCRPC (bone), 1^st-line treatment with abiraterone, 2^nd-line treatment with 6 cycles docetaxel

Current situation:

• Rising PSA: from 0.9 ng/ml to 3.9 ng/ml
• ECOG PS: 1
• Back pain
• MRI spine:
  • Progression of existing bone lesions and new bone lesions in multiple vertebrae
  • Enlarging soft tissue component at Th9 causing spinal cord compression
  • Neurosurgical decompression was performed
• Histology from neurosurgical decompression: metastatic poorly-differentiated PCa
• Somatic ATM mutation