David (67 years old)

David is 67 years old and maintains his physical condition by going for a walk in the woods every morning. Over the past few months, he noticed his endurance deteriorated. He was recently diagnosed with metastatic prostate cancer (PCa).

• Medical history: no abnormalities
• ECOG PS: 1
• Symptoms: back pain and weight loss over the last few months
• Bone scan: 8 metastases (4 on ribs, 4 on spine)
• CT: locally advanced prostatic mass, few enlarged pelvic lymph nodes, 2 liver metastases
• PSA: 63 ng/ml
• Prostate biopsy: ISUP grade 5 (Gleason 4+5)