Case 2025: Francisco (expert opinion by B. Tombal)

Francisco, 65 years old, grew up in Alfama where every June he helped his mother grill sardines during the Festas de Santo António. The smoky aroma and lively music became part of his childhood. Today, he runs a small tasca where each plate of sardines carries that same spirit of Lisbon’s summer nights. Unfortunately, he is diagnosed with PCa during a check-up.

• Medical history: well-controlled hypertension, no significant cardiac or renal issues
• ECOG PS: 0
• PSA: 12 ng/ml
• DRE: cT2b
• mpMRI: 7 mm PI-RADS 4 lesion lateral right, no extracapsular extension, prostate volume 41 ml, suspicious right external iliac LN
• Transperineal MRI-guided prostate biopsy: 3/3 biopsies positive for ISUP grade group 3 (Gleason 4+3) in index, no cancer detected in perilesional biopsies
• No clinical symptoms