Carlos (68 years old)

Carlos, a 68-year-old retired manager of an Italian restaurant, was diagnosed with high-risk PCa (cT3N0M0; ISUP grade 4 [Gleason score 4+4]; PSA 38 ng/ml). He was treated with EBRT + 24 months ADT. His PSA nadir was 0.7 ng/ml.

Two years after completion of ADT:

• PSA increased to 3.1 ng/ml
• CT scan showed enlarged pelvic lymph nodes
• Bone scan was negative

ADT was started again; PSA nadir was 0.9 ng/ml.

18 months after start of ADT:

• PSA increased to 7.6 ng/ml
• Bone scan showed 3 bone metastases; treatment with denosumab was started
• Moderate pain; well controlled by non-steroidal anti-inflammatory drugs (NSAID)
• Alkaline phosphatase (ALP): 132 U/l
• Serum testosterone: 12 ng/dl
• CT scan showed stable lymph nodes, no signs of visceral metastasis
• Eastern Cooperative Oncology Group Performance Status (ECOG PS): 1