Pedro (59 years old)

Pedro, 59 years old, was diagnosed with high-risk bone metastatic PCa (>10 bone metastases on bone scan; CT showed no visceral metastasis). ISUP grade 4 (Gleason score 4+4). He was treated with ADT + abiraterone. 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, 24 months after starting abiraterone. Recent diagnostic work-up showed patient now has mCRPC:

• Serum testosterone: 16 ng/dl (0.6 nmol/l)
• PSA: 20 ng/ml
• Bone scan: 4 new bone lesions not present on scans 6 and 12 months ago
• CT scan showed no visceral metastasis
• No germline and/or somatic BRCA1/2 mutation identified