Osvald (72 years old)

Osvald, 72 years old, is a retired captain and lives near the sea shore. Since his retirement, he goes for a daily walk to the local harbour. Due to the bone pain, he is experiencing during the last months, he now regularly decides to stay at home.

He was diagnosed with high-risk PCa 9 years ago (pT3aN0, ISUP grade 4, postoperative PSA <0.1 ng/ml). 2 years after diagnosis he began ADT alone for metastatic relapse in the bones. The disease progressed to mCRPC 5 years ago. He received enzalutamide as first-line and 6 cycles docetaxel as second-line therapy.

Follow-up today (4 months after stopping docetaxel):

• No comorbidities
• No relevant family history
• ECOG PS: 1
• Fairly well controlled pain (VAS score 3)
• Rising PSA: 110 ng/ml
• PSMA-PET/CT: progression in bone and LNs (max 3.5 cm in short axis) and liver (all lesions PSMA positive and higher PSMA expression than liver)
• No germline and/or somatic HRR/BRCA mutation identified