Case 2024: Lorenz (expert opinion by A. Merseburger)

Lorenz, 58 years old, is a big opera enthusiast. He has a subscription to the Vienna State Opera, where he regularly enjoys operas and ballet evenings. He’s aware that he’s not the best singer, but after spending an evening there, he cannot stop himself from singing the whole way back home.

Lorenz was diagnosed with multiple bone metastatic PCa (PSA: 385 ng/ml) almost 3 years ago. He has no major comorbidities.

Course of the disease:

• Treatment with ADT + 6 cycles of docetaxel. His PSA 6 months after starting chemohormonal therapy was 2.1 ng/ml, ALP 31 U/l
• At 24 months post-ADT initiation:
  • PSA confirmed rise, now 11 ng/ml
  • Castrate testosterone level
  • Bone scan: progression of bone metastases
  • CT scan: 1 visceral metastasis (lung)
  • Bone pain: requires paracetamol
  • ECOG PS: 1
• Treatment for mCRPC was started with abiraterone, 12 weeks later:
  • PSA: 4.1 ng/ml
  • Bone scan: no new lesions
  • Lung metastasis responding
• Now, 9 months after starting abiraterone:
  • PSA: 20 ng/ml, ALP: 185 U/l
  • CT scan: new lung and lymph node metastases
  • ECOG PS: 1
  • No germline and/or somatic BRCA1/2 mutation identified
  • Symptoms: bone pain still controlled with paracetamol alone