Case 2024: Stefan (expert opinion by E. Castro)

Stefan, 72 years old, appreciates the Viennese tradition of relaxing in a coffee house. He loves reading the newspapers while sipping of his Wiener Melange.

He was diagnosed with high-volume mHSPC 3 years ago (PSA 325 ng/ml, multiple bone metastases) and treatment with ADT + enzalutamide was started. His PSA dropped to 8 ng/ml.

Current situation:

• Medical history: hypertension, under control with ACE-inhibitor (enalapril)
• ECOG PS: 1
• Symptoms: mild hip pain, under control with NSAIDs
• PSMA-PET/CT:
  • Pelvic and retroperitoneal LNs (all <3 cm)
  • Progression of bone metastases
• PSA: 54 ng/ml
• Testosterone: 17 ng/dl (0.59 nmol/l)
• Somatic tumour testing: CDK12 mutation