ADT + ARPI + DOC mHSPC, progressing to mCRPC.

2 yr ago: PSA 456 ng/ml, bone & CT scan: 8 bone mets (4 on vertebral bodies, 2 on pelvis and 2 on ribs).

ADT+DOC+DARO started. After 6 cycles, PSA ↓ to 5 ng/ml.

Current situation, 1.5 years after stopping DOC, tx with DARO still ongoing:

No comorbidities, asymptomatic, ECOG PS: 0, no relevant family history
Rising PSA: 40 ng/ml, T: 17 ng/dl (0.59 nmol/l)
Bone & CT scan: pelvic and retroperitoneal LNs (all <3 cm), progression of existing bone mets and 1 new mets on femur (9 mets in total)
PSMA-PET/CT: concordant with CT and bone scan, all lesions PSMA positive and higher PSMA expression than liver
No germline or somatic mutations detected

Score of experts

Uromigos score (range: 0-3)

As not all drugs have the same clinical impact despite getting similar guideline levels of recommendation, the Uromigos Score is designed to quantify clinical support for various approaches. We asked each expert to score a given treatment according to the following:

3 Undisputed SOC

2 Potentially inferior to SOC but a reasonable option

1 Has a limited role

0 Should be avoided

Only 1 option can be selected with Score 3. We assumed patients are fit/eligible/appropriate for all treatment options without contraindications, preferences, or limitations of availability/funding. The mean of all scores is presented.

Reference: Uromigos Score — The Uromigos

Mean Uromigos score

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*EAU 2025 guidelines: Evidence is limited for 2^nd- or 3^rd-line use of DOC after prior DOC for mHSPC. NCCN v5.2026 guidelines: DOC rechallenge post-ARPI/post-DOC is a preferred option, listed after cabazitaxel