Case 2026: Theo (expert opinion by F. Turco)

Theo, 72 years old, regularly takes the train to Amsterdam to visit small galleries and second-hand bookshops. He enjoys browsing without a plan and often returns home with an old photography book or a vintage map. Each time, his wife wonders what treasure he will bring home next.

3 years ago, Theo was diagnosed with high-risk PCa:

• cT3N0M0, ISUP grade 4, PSA: 17 ng/ml
• He was treated with EBRT + 24 months of ADT
• PSA nadir was 0.25 ng/ml

1 year ago:

• PSA 2.9 ng/ml; serum testosterone 315 ng/dl (10.9 nmol/l)
• Bone and CT scan: 2 enlarged pelvic lymph nodes, no bone or visceral metastases
• ADT was restarted continuously
• PSA nadir was 0.9 ng/ml

Now, Theo has mCRPC:

• Medical history: well-controlled hypertension
• ECOG PS: 0, G8 score: 15/17
• Asymptomatic
• PSA: 18.6 ng/ml, serum testosterone: 14 ng/dl (0.49 nmol/l)
• Lab values: normal
• Bone scan: 5 bone metastases (3 on vertebrae, 1 on the pelvis, 1 on the left femur), not present on conventional imaging 6 months ago
• CT scan: stable lymph nodes, no signs of visceral metastasis
• No actionable germline or somatic mutations identified

Treatment with denosumab was started.