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

Guillaume (67 years old)

Guillaume, 67 years old, used to provide logistical support for the hospital’s emergency service. Since he became ill himself, his former colleagues try to pass by every time he needs to be in the hospital. 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
  • Molecular testing: pathogenic germline PALB2 variant
  • 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?