Prostate cancer
Treatment selection in mCRPC patients harbouring HRR gene mutations

Case 2: Artur

Artur, 71 years old, has a history of PCa.

Medical history:

  • Diagnosed with high-volume mHSPC 4 years ago
    • PSA: 128 ng/ml
    • Bone and CT scan: multiple bone metastases
    • Treatment with ADT + enzalutamide was started
    • PSA nadir was 0.7 ng/ml

Current situation:

  • ECOG PS: 0
  • Symptoms: mild back pain, under control with NSAIDs
  • Bone and CT scan: progression of bone metastases, few positive pelvic and retroperitoneal lymph nodes (all <3 cm), no visceral metastases
  • PSMA-PET/CT: concordant with CT and bone scan, all lesions PSMA positive and higher PSMA expression than liver
  • Testosterone: 19 ng/dl (0.7 nmol/L)
  • Somatic tumour testing: ATM mutation

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