Olaf (71 years old)

Olaf, 71 years old, used to spend hours in his vegetable garden every day. Since a few months, he works less and less in his garden because of back pain. Unfortunately his disease progressed to bone-metastatic CRPC.

Course of the disease:

• 5 years ago: RP + ePLND for high-risk PCa (pT3aN0M0, ISUP grade 4, undetectable postoperative PSA)
• 1 year later: salvage EBRT + 6 months adjuvant ADT for rising PSA (0.4 ng/ml)
• 2 years later: PSA 5.4 ng/ml, negative bone and CT scan; start ADT monotherapy
• 14 months later: PSA 7.7 ng/ml, serum testosterone 15 ng/dl, CT scan: retroperitoneal lymph nodes up to 5 cm short-axis diameter, ALP 71 U/l. The patient, now having CRPC, was treated with enzalutamide and the PSA dropped to 1.9 ng/ml. The lymph node metastases shrank by 36% (RECIST).

Now, 10 months after starting enzalutamide:

• PSA: 26.8 ng/ml
• CT scan:
  • Radiographic progression of lymph nodes (43% increase from nadir post-enzalutamide, i.e. >3 cm)
  • No visceral metastases
• Bone scan: 4 metastases; the patient experienced mild bone pain
• ALP: 185 U/l
• ECOG PS: 1
• No germline and/or somatic HRR/BRCA mutation identified