Prostate cancer
CRPC: treatment in daily clinical practice

Ludo (74 years old)

Ludo, 74 years old, was a fanatic pigeon fancier when he was younger. Due to knee problems, which resulted in a knee replacement at the age of 70 years, he limited his hobby to keeping some pigeons in a pigeon loft in the garden.

He was diagnosed with high-risk localised PCa at the age of 66 years, with a PSA of 22 ng/ml and urinary symptoms. He opted for radiotherapy and was treated with EBRT + 3 years of ADT. 

6.5 years after diagnosis, PSA increase to 3.0 ng/ml prompted imaging with CT and bone scan which did not show any abnormalities. ADT was initiated and PSA decreased to 0.5 ng/ml.

Follow-up information today, 1.5 years after initiation of continuous ADT:

  • ECOG PS: 0
  • PSA: 2.1 ng/ml
  • PSA-DT: 8.5 months
  • Serum testosterone: 16 ng/dl
  • Bone and CT scan: no metastases

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