Prostate cancer
NEW --- Treatment selection in mCRPC patients harbouring HRR gene mutations

Owen (67 years old)

Owen, 67 years old, is a former weatherman. After his retirement, he built his own small weather station to predict the weather and record data. Unfortunately, some people still get angry with him when the weather is bad. He was diagnosed with high-volume, high-risk mHSPC 2 years ago (PSA 456 ng/ml, multiple bone metastases) and treatment with ADT + docetaxel was started. After 6 cycles, his PSA dropped to 5 ng/ml.

Current situation, 1.5 years after stopping docetaxel:

  • No comorbidities
  • Family history:
    • Father died of PCa at age of 64 years
    • Brother diagnosed with high-risk PCa at age of 61 years
  • Germline testing: BRCA2 carrier
  • ECOG PS: 0
  • Asymptomatic
  • Rising PSA: 40 ng/ml
  • Testosterone: 17 ng/dl (0.59 nmol/l)
  • CT and bone scan: pelvic and retroperitoneal LNs (all <3 cm), progression of bone metastases

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