Case 2: CRPC and 1 positive lesion on PSMA-PET/CT

A 67-year-old retired journalist, still occasionally writes a column or two for his favourite local newspaper. Otherwise a healthy man, he was diagnosed with high-risk PCa (cT2b, biopsy ISUP grade 3 [Gleason score 4+3]) and treated with RP + ePLND.

• Pathology report: pT3aN0M0 PCa, negative surgical margins
• Postoperative PSA: 0.03 ng/ml

1 year later, the PSA rose to 0.18 ng/ml. He was treated with salvage EBRT which resulted in an undetectable PSA.

Again 1 year later, the PSA increased to 1.30 ng/ml (N0M0 on bone scan and CT). He received ADT; PSA: 0.09 ng/ml.

However, 2 years later the PSA level increased to 4.8 ng/ml, with a PSA-DT of 5 months (serum testosterone 18 ng/dl).

• Bone and CT scan: N0 M0 disease
• PSMA-PET/CT scan: 1 positive bone lesion (left pedicle of L2)