Case 2026: Anton (expert opinion by A. Bahl)

Anton, 69 years old, spends 3 days a week volunteering at a local museum. He cycles there and welcomes visitors, bringing Amsterdam's history to life through his stories. He enjoys the sense of purpose the role provides and appreciates the chance to interact with people from all walks of life. It helps him stay active and engaged, which is important to him.

Recently, Anton was diagnosed with mHSPC. His baseline PSA was 18.8 ng/ml and ADT was started. Now, a few weeks later, he visits the clinic to discuss further management.

• Medical history: type 2 diabetes (on metformin) and well-controlled hypercholesterolaemia (on simvastatin)
• ECOG PS: 0
• PSA: 10.1 ng/ml
• Lab values: normal
• Prostate biopsy: ISUP grade group 4 (Gleason score 4+4)
• Bone scan: 3 bone metastases (1 lesion in the left iliac bone, 1 in the lumbar spine and 1 in the right rib)
• CT: locally advanced prostatic mass; 3 sclerotic bone lesions, no enlarged pelvic or retroperitoneal lymph nodes, no enlarged pelvic or retroperitoneal lymph nodes, no evidence of visceral metastases
• No actionable germline or somatic mutations detected