Curious about the case challenges? Compare yourself with your peers, and challenge the RENALC-BLADDR-PROSCA faculty.
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.
Regulatory approval and local restrictions aside, which option would you choose for Miguel?
(click on the option you would recommend & scroll down to compare your answer with Dr. Ursula Vogl)
A: ADT + 6x docetaxel
B: ADT + abiraterone
C: ADT + apalutamide
D: ADT + darolutamide
E: ADT + enzalutamide
F: ADT + 6x docetaxel + abiraterone
G: ADT + 6x docetaxel + darolutamide
Teresa, 65 years old, loves to prepare her famous cod in the kitchen of her apartment, just as her grandmother taught her. Besides being a prominent painter, known for her vibrant depictions of Portugal’s coastlines, she is also a go-to expert on traditional Portuguese cooking. Her family gladly gathers around the table every Sunday to enjoy the family recipes.
Unfortunately, a small renal mass (SRM) was recently found in her left kidney. 
Assessment summary:
- Medical history:
- Moderate COPD (GOLD II)
- Crohn’s disease
- Blood work:
- eGFR: 45 ml/min/1.73m2
- Hb: 11.2 g/dl (normal range: 13.6-17.7 g/dl)
- Abdominal contrast-enhanced CT: SRM
- Undetermined; equivocal enhancement patterns
- Size 3.1 cm
- Location: upper pole, exophytic growth
- cT1a
Regulatory approval and local restrictions aside, which option would you choose for Teresa?
(click on the option you would recommend & scroll down to compare your answer with Dr. Teele Kuusk)
A. Ablative therapy with prior biopsy or 89Zr-DFO-girentuximab PET/CT
B. Partial nephrectomy with or without prior biopsy or 89Zr-DFO-girentuximab PET/CT
C. Active surveillance with or without prior biopsy or 89Zr-DFO-girentuximab PET/CT
D. SBRT with or without prior biopsy or 89Zr-DFO-girentuximab PET/CT
Ines, 69 years old, has her own atelier. Over the years, countless tourists have unleashed their creativity during her tile-painting workshops, but her greatest pride is her latest group of adolescents who mastered the challenging art of tile-making after an intensive course.
Ines is diagnosed with metastatic UCa of bladder during a workup for dysuria. 
Assessment summary:
- Medical history: controlled type 2 diabetes mellitus, dry skin
- CT scan of chest, abdomen and pelvis: bone and lung metastases, biopsy compatible with UCa
- ECOG PS: 1
- No peripheral neuropathy
- Audiometric hearing loss: grade 1
- GFR: 90 ml/min
- Cardiac ejection fraction: 60%
- Normal blood glucose levels
Enfortumab vedotin (EV) + pembrolizumab was started; however, on day 15 of the 1st cycle, the patient presented with pruritus and erythematous macules on the lower legs and soles, covering 20% of the body surface area.
Dermatologic assessment:
- Grade 2 non-specific maculopapular rash, treated with topical corticosteroids, oral antihistamines and emollients
- No improvement, nor worsening after 1 week
- Dermatologist: likely attributable to EV
The patient continues to receive topical corticosteroids, oral antihistamines and emollients. EV + pembrolizumab was withheld and 3 weeks later the skin reaction improved to grade 1.
Regulatory approval and local restrictions aside, which option would you suggest for Ines?
(click on the option you would recommend & scroll down to compare your answer with Dr. Bernadett Szabados)
A. Resume full dose EV + full dose pembrolizumab
B. Permanently discontinue both EV + pembrolizumab
C. Switch to reduced dose EV, resume full dose pembrolizumab
D. Permanently discontinue EV, resume full dose pembrolizumab
E. Resume full dose EV, permanently discontinue pembrolizumab
F. Switch to reduced dose EV, permanently discontinue pembrolizumab
Ines, 69 years old, has her own atelier. Over the years, countless tourists have unleashed their creativity during her tile-painting workshops, but her greatest pride is her latest group of adolescents who mastered the challenging art of tile-making after an intensive course.
Ines is diagnosed with metastatic UCa of bladder during a workup for dysuria.
Assessment summary:
- Medical history: controlled type 2 diabetes mellitus, dry skin
- CT scan of chest, abdomen and pelvis: bone and lung metastases, biopsy compatible with UCa
- ECOG PS: 1
- No peripheral neuropathy
- Audiometric hearing loss: grade 1
- GFR: 90 ml/min
- Cardiac ejection fraction: 60%
- Normal blood glucose levels
Enfortumab vedotin (EV) + pembrolizumab was started; however, on day 15 of the 1st cycle, the patient presented with pruritus and erythematous macules on the lower legs and soles, covering 20% of the body surface area.
Dermatologic assessment:
- Grade 2 non-specific maculopapular rash, treated with topical corticosteroids, oral antihistamines and emollients
- No improvement, nor worsening after 1 week
- Dermatologist: likely attributable to EV
The patient continues to receive topical corticosteroids, oral antihistamines and emollients. EV + pembrolizumab was withheld and 3 weeks later the skin reaction improved to grade 1.
Regulatory approval and local restrictions aside, which option would you suggest for Ines?
(click on the option you would recommend & scroll down to compare your answer with Dr. Bernadett Szabados)
A. Resume full dose EV + full dose pembrolizumab
B. Permanently discontinue both EV + pembrolizumab
C. Switch to reduced dose EV, resume full dose pembrolizumab
D. Permanently discontinue EV, resume full dose pembrolizumab
E. Resume full dose EV, permanently discontinue pembrolizumab
F. Switch to reduced dose EV, permanently discontinue pembrolizumab
Ines, 69 years old, has her own atelier. Over the years, countless tourists have unleashed their creativity during her tile-painting workshops, but her greatest pride is her latest group of adolescents who mastered the challenging art of tile-making after an intensive course.
Ines is diagnosed with metastatic UCa of bladder during a workup for dysuria.
Assessment summary:
- Medical history: controlled type 2 diabetes mellitus, dry skin
- CT scan of chest, abdomen and pelvis: bone and lung metastases, biopsy compatible with UCa
- ECOG PS: 1
- No peripheral neuropathy
- Audiometric hearing loss: grade 1
- GFR: 90 ml/min
- Cardiac ejection fraction: 60%
- Normal blood glucose levels
Enfortumab vedotin (EV) + pembrolizumab was started; however, on day 15 of the 1st cycle, the patient presented with pruritus and erythematous macules on the lower legs and soles, covering 20% of the body surface area.
Dermatologic assessment:
- Grade 2 non-specific maculopapular rash, treated with topical corticosteroids, oral antihistamines and emollients
- No improvement, nor worsening after 1 week
- Dermatologist: likely attributable to EV
The patient continues to receive topical corticosteroids, oral antihistamines and emollients. EV + pembrolizumab was withheld and 3 weeks later the skin reaction improved to grade 1.
Regulatory approval and local restrictions aside, which option would you suggest for Ines?
(click on the option you would recommend & scroll down to compare your answer with Dr. Bernadett Szabados)
A. Resume full dose EV + full dose pembrolizumab
B. Permanently discontinue both EV + pembrolizumab
C. Switch to reduced dose EV, resume full dose pembrolizumab
D. Permanently discontinue EV, resume full dose pembrolizumab
E. Resume full dose EV, permanently discontinue pembrolizumab
F. Switch to reduced dose EV, permanently discontinue pembrolizumab
Antonio, 67 years old, owns a cosy café in Lisbon, where locals gather daily to savour a perfectly brewed bica. Antonio is not only appreciated for his rich espresso and the warm atmosphere; also his loyal friendship contributes to keeping the café culture alive.
Unfortunately, Antonio was recently diagnosed with mHSPC. 
- Medical history: no abnormalities
- ECOG PS: 0
- PSA: 41 ng/ml
- Prostate biopsy: ISUP grade group 4 (Gleason score 4+4)
- Bone scan: 3 metastases (on vertebral bodies)
- CT: locally advanced prostatic mass; no lymph node or visceral metastatic disease
Antonio went to a different hospital to get a second opinion.
- PSMA-PET/CT: 9 metastases (6 on vertebral bodies, 1 in left ischium and 2 on the left rib), few positive pelvic LNs
- He will start treatment with ADT
Regulatory approval and local restrictions aside, which option would you choose for Antonio?
(click on the option you would recommend & scroll down to compare your answer with Dr. Amit Bahl)
A: ADT + DOC
B: ADT + ARPI
C: ADT + RT to the prostate
D: ADT + DOC + ARPI
E: ADT + ARPI + RT to the prostate
F: ADT + DOC + ARPI + RT to the prostate
Antonio, 67 years old, owns a cosy café in Lisbon, where locals gather daily to savour a perfectly brewed bica. Antonio is not only appreciated for his rich espresso and the warm atmosphere; also his loyal friendship contributes to keeping the café culture alive.
Unfortunately, Antonio was recently diagnosed with mHSPC.
- Medical history: no abnormalities
- ECOG PS: 0
- PSA: 41 ng/ml
- Prostate biopsy: ISUP grade group 4 (Gleason score 4+4)
- Bone scan: 3 metastases (on vertebral bodies)
- CT: locally advanced prostatic mass; no lymph node or visceral metastatic disease
Antonio went to a different hospital to get a second opinion.
- PSMA-PET/CT: 9 metastases (6 on vertebral bodies, 1 in left ischium and 2 on the left rib), few positive pelvic LNs
- He will start treatment with ADT
Regulatory approval and local restrictions aside, which option would you choose for Antonio?
(click on the option you would recommend & scroll down to compare your answer with Dr. Amit Bahl)
A: ADT + DOC
B: ADT + ARPI
C: ADT + RT to the prostate
D: ADT + DOC + ARPI
E: ADT + ARPI + RT to the prostate
F: ADT + DOC + ARPI + RT to the prostate
Antonio, 67 years old, owns a cosy café in Lisbon, where locals gather daily to savour a perfectly brewed bica. Antonio is not only appreciated for his rich espresso and the warm atmosphere; also his loyal friendship contributes to keeping the café culture alive.
Unfortunately, Antonio was recently diagnosed with mHSPC.
- Medical history: no abnormalities
- ECOG PS: 0
- PSA: 41 ng/ml
- Prostate biopsy: ISUP grade group 4 (Gleason score 4+4)
- Bone scan: 3 metastases (on vertebral bodies)
- CT: locally advanced prostatic mass; no lymph node or visceral metastatic disease
Antonio went to a different hospital to get a second opinion.
- PSMA-PET/CT: 9 metastases (6 on vertebral bodies, 1 in left ischium and 2 on the left rib), few positive pelvic LNs
- He will start treatment with ADT
Regulatory approval and local restrictions aside, which option would you choose for Antonio?
(click on the option you would recommend & scroll down to compare your answer with Dr. Amit Bahl)
A: ADT + DOC
B: ADT + ARPI
C: ADT + RT to the prostate
D: ADT + DOC + ARPI
E: ADT + ARPI + RT to the prostate
F: ADT + DOC + ARPI + RT to the prostate