Case 1: Fabrice (56 years old)

Fabrice, 56 years old, likes to write poems in his free time, but hasn’t had his breakthrough yet. He feels the world is not ready for his poetry, and is convinced it will be published posthumously. Fabrice was diagnosed with mHSPC 3 years ago (PSA 456 ng/ml, multiple bone metastases) and treatment with ADT + abiraterone was started. His PSA dropped to 5 ng/ml.

Current situation:

No comorbidities
Family history:
- Father died of PCa at age of 62 years
- Brother diagnosed with high-risk PCa at age of 59 years
ECOG PS: 0
Asymptomatic
Rising PSA: 30 ng/ml
Testosterone: 17 ng/dl (0.59 nmol/l)
CT and bone scan: pelvic and retroperitoneal LNs, progression of bone metastases

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

Perform germline molecular testing and start therapy after having the results

Perform somatic molecular testing and start therapy after having the results

Start therapy (other than PARPi) and do not perform germline/somatic molecular testing

Start therapy (other than PARPi) and perform germline/somatic molecular testing during therapy

Start therapy including PARPi without germline/somatic molecular testing