Prostate cancer
CRPC: treatment in daily clinical practice

George (68 years old)

George, a 68-year-old retired English teacher, loves poetry and even wrote a couple of outstanding poetry books himself. He 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.

2 years after completion of ADT:

  • PSA: 3.1 ng/ml
  • CT scan: enlarged pelvic lymph nodes
  • Bone scan: negative

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

18 months after start of ADT:

  • PSA: 7.6 ng/ml
  • Bone scan: 3 bone metastases; treatment with denosumab was started
  • Moderate pain; well controlled by NSAIDs
  • ALP: 132 U/l
  • Serum testosterone: 12 ng/dl
  • CT scan: stable lymph nodes, no signs of visceral metastasis
  • ECOG PS: 1
  • No germline and/or somatic BRCA1/2 mutation identified

Which treatment option would you choose for this patient?