Herman (71 years old)

Herman, 71 years old, was diagnosed with high-risk PCa (cT2b; ISUP grade 4 [Gleason score 4+4]; PSA 11 ng/ml). He underwent RP + ePLND (pT3aN0M0, ISUP grade 4 [Gleason score 4+4]). Postoperative PSA was undetectable.

One year later the patient had a biochemical recurrence (PSA 0.4 ng/ml) and received salvage EBRT + 6 months adjuvant ADT.

Two years later:

• PSA increased to 5.4 ng/ml
• PSA-DT: 7 months
• Bone scan and CT scan negative

The patient was treated with ADT.

14 months later:

• PSA rising to 7.7 ng/ml
• PSA-DT: 6 months
• Serum testosterone: 15 ng/dl
• CT scan showed retroperitoneal lymph nodes up to 5 cm short-axis diameter
• ALP: 71 U/l

The patient, now having CRPC, was treated with docetaxel and the PSA dropped to 1.9 ng/ml. The lymph node metastases shrank by 36% (RECIST).

Ten months after starting docetaxel:

• PSA increased to 26.8 ng/ml
• Radiographic progression of lymph nodes (43% increase from nadir post-docetaxel)
• Bone scan showed 4 metastases and the patient experienced mild bone pain
• ALP: 185 U/l
• No visceral metastases
• ECOG PS: 1