Case 2025: Miguel (expert opinion by U. Vogl)

As a former local historian and tour guide, the 69-year-old Miguel used to share his deep knowledge of Sintra’s palaces, gardens and legends with visitors. Until recently, he still visited the cultural heritage and didn’t hesitate to step in and correct his successors if they made a mistake.

Unfortunately, Miguel was recently diagnosed with mHSPC.

• Medical history: ischemic heart disease (cardiovascular event >10 years ago) and well-controlled hypertension, receiving a beta blocker (bisoprolol), a statin (atorvastatin), acetylsalicylic acid and an ACE inhibitor (lisinopril)
• ECOG PS: 1
• PSA: 56 ng/ml
• Prostate biopsy: ISUP grade group 4 (Gleason score 4+4)
• Bone scan: 6 metastases (3 in the spine, 2 in the right hip and 1 in a rib)
• CT: locally advanced prostatic mass, osteoblastic bone metastases as described in the bone scan, few enlarged pelvic lymph nodes, no visceral metastases

He will start treatment with ADT.