Case 1: Jens (68 years old)

Jens is a 68-year-old retired firefighter. As a volunteer, he still leads meetings to provide tips to prevent fire at home. He was earlier diagnosed with high-risk PCa (cT3N0M0; ISUP grade 4; PSA 18 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
• Testosterone: 312 ng/dl (10.8 nmol/l)
• 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 (0.42 nmol/l)
• CT scan: stable lymph nodes, no signs of visceral metastasis
• ECOG PS: 1
• No germline and/or somatic HRR/BRCA mutation identified