Victor (67 years old)

Victor, a 67-year-old retired sales man of a big car company, was diagnosed with high-risk prostate cancer (PCa) (cT2b, biopsy ISUP grade 3 [Gleason score 4+3]). He was treated with radical prostatectomy (RP) + extended pelvic lymph node dissection (ePLND).
The pathology report showed:

• pT3a N0M0 PCa
• No seminal vesicle invasion
• Negative surgical margins

Postoperative prostate-specific antigen (PSA) was 0.03 ng/ml.

One year later the PSA rose to 0.18 ng/ml and the patient was treated with salvage external beam radiotherapy (EBRT) which resulted in an undetectable PSA.

Again 1 year later the PSA increased to 1.30 ng/ml (N0M0 on bone scan and CT). The patient received androgen deprivation therapy (ADT); PSA: 0.09 ng/ml.

However, 2 years later the PSA level increased to 4.8 ng/ml, with a PSA doubling time (PSA-DT) of 5 months (serum testosterone 18 ng/dl). The bone and CT scan were negative for metastasis.