Karl (59 years old)

Karl, 59 years old, was diagnosed with high-volume bone metastatic PCa (>10 bone metastases on bone scan of which 3 in the ribs and 1 in the humerus head; CT showed no visceral metastasis) almost 2 years ago. He was treated with ADT + docetaxel. Scans during and after therapy showed a good response. His PSA dropped from 251 ng/ml to 5 ng/ml.

Now, he has a follow-up appointment, 14 months after completing 6 cycles of docetaxel. Recent diagnostic work-up showed he now has mCRPC:

• Serum testosterone: 16 ng/dl (0.6 mmol/l)
• PSA: 20 ng/ml
• Bone scan: 4 new bone lesions not present on scans 6 and 12 months ago
• Mild bone pain
• CT scan showed no visceral metastasis
• No germline and/or somatic HRR/BRCA mutation identified