Case 2025: Vicente (expert opinion by A. Choudhury)

Vicente, 70 years old, always enjoys a short evening stroll with the sun low in the sky and the warm breeze from the river. Lately, his endurance has deteriorated, so he now pauses to take some rest at the majestic Bélem Tower.

4 years ago, he was diagnosed with high-volume metastatic prostate cancer:

• Bone and CT scan: 5 bone metastases (3 on vertebrae, 1 on the pelvis, 1 on a rib), no visceral metastases
• Treatment with ADT + docetaxel was started
• Good biochemical and radiographic response (PSA of 56 ng/ml dropped to a nadir value of 2.3 ng/ml)

Current situation, 3 years after completing 6 cycles of docetaxel. Vicente is now diagnosed with mCRPC.

• Medical history: well-controlled hypertension
• Asymptomatic
• ECOG PS: 0
• Serum testosterone: 20 ng/ml
• PSA: 21 ng/ml
• Bone and CT scan: progression of existing bone metastases and 4 new bone metastases (2 on vertebrae, 1 on the pelvis, 1 on the left femur) that were not present on scans 6 months ago, no visceral metastases
• No germline or somatic mutations identified