Case 2024: Simon (expert opinion by G. Kramer)

Simon, 68 years old, used to be a captain on an excursion boat that navigates the Danube during spring and summer. He loved showing tourists around his beloved river. Lately he experienced back pain, for which he consulted his GP. Unfortunately, he was diagnosed with metastatic PCa.

Assessment summary:

• Medical history: atrial fibrillation, receiving an oral anticoagulant (apixaban) and a statin (simvastatin)
• ECOG PS: 1
• Symptoms: mild back pain, mostly under control with NSAIDs
• PSMA-PET/CT:
  • Locally advanced prostatic mass
  • Few enlarged pelvic lymph nodes
  • 5 bone metastases (3 on spine, 1 on pelvis, 1 on left humerus)
  • No sign of visceral metastasis
• PSA: 62 ng/ml
• Prostate biopsy: ISUP grade group 4 (Gleason score 4+4)

He will start treatment with an injectable LHRH agonist or antagonist.