Minimally symptomatic, PSA raised at 4.1, MRI PIRADS 4 lesion, biopsied with Gleason 4+5=9. Underwent RP in December of 2024, PSA post 0.011, then 0.01 for 12 months then biochemical recurrence with PSA of 0.058 rising to 0.1
PSMA PET displaying two small bony lesions, one in the Left scapula and one in the femoral head.

Underwent MDT 27 Gy in 3 fractions to both lesions and commenced on ADT + enzlutamide.

Within 4 weeks, PSA undetectable <0.01 and Testosterone <0.2. Hot flushes but no other significant side effects as yet. No complications with MDT.