Case 2024: Theo (expert opinion by M. De Santis)

Theo, 61 years old, works as a guide in Vienna’s Natural History Museum. He never dares to admit it, but every time he has to leave the building when it was already dark, the huge dinosaur skeletons creeped him out a bit. He was diagnosed with metastatic PCa, after a visit to his primary care physician for urinary symptoms and persistent lower back pain over the last 3 months.

Assessment summary:

• Medical history: well-controlled hypertension, hyperlipidaemia, diabetes mellitus with mild polyneuropathy in hands and feet, osteoarthritis in the knees
• ECOG PS: 1
• Symptoms: persistent lower back, hip and rib pain, urinary frequency, nocturia, mild fatigue and decreased appetite
• PSA: 72 ng/ml
• Prostate biopsy: ISUP grade group 4 (Gleason score 4+4)
• CT and bone scan: enlarged prostate gland, enlarged pelvic and para-aortic LNs, 2 bone metastases (lumbar spine L3 and left femur head), no sign of visceral metastases
• PSMA-PET/CT:
  • Locally advanced prostatic mass
  • Multiple positive lesions in pelvic, para-aortic and mediastinal lymph nodes
  • Extensive bone lesions (throughout the axial and appendicular skeleton, including spine (L3, L4, L5), multiple ribs bilateral, left femur)
  • No sign of visceral metastases

He prefers to avoid chemotherapy due to concerns about side effects and he wishes to maintain quality of life. He’s mostly concerned about potential side effects impacting mobility, cognition and daily functioning.