Figure 3.

A 57-year-old man, diagnosed with locally advanced PCa in 2019 (Gleason score 4 + 5, ISUP 5), progressive after a sequence of various therapeutic regimens due to skeletal metastases (ADT, second generation androgens, taxane chemotherapy), positive for ATM germline mutation at NGS analysis. He was referred to our facility for ²²³Ra-therapy: pre-therapy whole body PET/CT with ¹⁸F-choline (A) showed increased tracer incorporation in the entire skeleton, as well depicted also by sagittal fused PET/CT of the spine (B). PET/CT’s findings were consistent with bone scan (C), left side—anterior view, right side—posterior view) demonstrating a typical pattern of “super bone”. After 2 cycles, a biochemical ALP response was registered (79 U/L post 2 cycles vs. 326 U/L at baseline). Unfortunately, the patient discontinued therapy due overlapping pulmonary complications.