Case 2025: José (expert opinion by A. Rodriguez-Vida)

With his shopping basket in hand, the 69-year-old José visits the nearby Mercado da Ribeira every Sunday since he moved to Lisbon. He only selects the best artisanal cheeses and cured meats after carefully tasting them upfront. Unfortunately, José has relapsed with metachronous mHSPC.

• Medical history: 
  • 5 years ago: radical prostatectomy for T2N0M0 PCa, ISUP grade group 4 (Gleason score 4+4)
  • 4 years ago: early prostate bed salvage RT without ADT for biochemical recurrence (PSA: 0.31 ng/ml)

José was lost to follow-up as he had moved across the country, and presents again today:

• ECOG PS: 0
• Symptoms: back and hip pain, fatigue
• PSA: 11 ng/ml
• CT and bone scan
  • Multiple lymph nodes in pelvic, para-aortic and mediastinal areas
  • 14 bone metastases (5 on pelvis, 4 on spine, 4 on multiple ribs bilateral, 1 on right femur)
  • No sign of visceral metastasis
• No germline or somatic mutations detected
• He will start treatment with ADT

José desires to maintain his independence, and his day-to-day quality of life is his top priority.