Case 2026: Hendrik - Next-step (expert opinion by A. Bernard-Tessier)

Hendrik, 72 years old, used to work as a canal guide. He preferred the quieter early morning tours, when the water is calm and the city felt like it belonged to him again for a short moment. Now, his son sometimes takes him along on his own boat for a tour through the canals.

Hendrik has a history of PCa:

• 8 years ago: RP + ePLND for high-risk PCa (pT3aN0M0), ISUP grade group 4, undetectable postoperative PSA
• 6 years ago: salvage EBRT to the prostate bed without ADT for rising PSA (0.24 ng/ml)
• 4 years ago: ADT + abiraterone/prednisone for low-volume mHSPC (PSA 0.7 ng/ml, 2 bone metastases on the spine)
• 1.5 years ago: docetaxel for oligoprogressive mCRPC (PSA: 9.8 ng/ml, testosterone: 12 ng/dl (0.42 nmol/l), 4 metastases on the spine, 1 on the pelvis, small pelvic LNs), ADT continued throughout treatment

Current situation:

• Medical history: controlled hyperlipidaemia (on statin therapy)
• ECOG PS: 0
• Symptoms: back pain (under control with NSAIDs) and mild fatigue
• Lab values: normal
• PSMA PET/CT: progression in bone only with multiple PSMA-avid bone metastases (4 on spine, 2 on pelvis, 1 on left rib), stable small pelvic LNs, no visceral metastases

Molecular testing shows a somatic BRCA2 mutation and an AR-ligand binding domain mutation.