Scott (58 years old)

Scott, a 58-year-old carpenter, has no major comorbidities. He was diagnosed with multiple bone metastatic PCa:

• CT scan: prostatic enlargement, no sign of visceral metastases
• PSA: 385 ng/ml
• ISUP grade 3 [Gleason score: 4+3]
• Asymptomatic but experiences fatigue

He was treated with ADT + 6 cycles of docetaxel. His PSA at 6 months was 2.1 ng/ml, ALP 31 U/l.

At 24 months post-ADT initiation:

• Increase in PSA to 24 ng/ml in 8 months
• Castrate testosterone level
• Bone scan shows progression of bone metastases
• CT scan shows 1 visceral metastasis (lung)
• Bone pain: requires paracetamol
• ECOG PS: 1

Treatment for mCRPC was started with abiraterone:

• PSA dropped to 4.1 ng/ml
• Bone metastases shrank by 20% (RECIST)

9 months after starting abiraterone:

• PSA rise to 20 ng/ml, ALP to 185 U/l
• Radiographic progression of lymph nodes and lung metastasis
• ECOG PS: 1