Prostate cancer
CRPC: treatment in daily clinical practice

Sam (59 years old)

Sam, 59 years old, was diagnosed with high-volume bone metastatic PCa (>10 bone metastases on bone scan of which 3 in the ribs and 1 in the humerus head; CT showed no visceral metastasis). He was treated with ADT + docetaxel. Scans during and after therapy showed a good response. His PSA dropped from 251 ng/ml to 5 ng/ml.

Now, he has a follow-up appointment, 14 months after completing 6 cycles of docetaxel. Recent diagnostic work-up showed he now has mCRPC:

  • Serum testosterone: 16 ng/dl (0.6 mmol/l)
  • PSA: 20 ng/ml
  • Bone scan: 4 new bone lesions not present on scans 6 and 12 months ago
  • CT scan showed no visceral metastasis
  • No germline and/or somatic BRCA1/2 mutation identified

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