[EARLY DETECTION OF BONE METASTASIS BY WHOLE-BODY MRI AND TRIPLET THERAPY AFTER RADICAL PROSTATECTOMY: A CASE REPORT].

(Background) Although radical prostatectomy is a curative treatment for localized prostate cancer, some high-risk patients experience early recurrence due to occult metastases undetected by conventional imaging. (Case presentation) A 53-year-old man with high-risk prostate cancer (cT2bN0M0, Gleason score 4+4, initial PSA 10.6 ng/mL) underwent robot-assisted radical prostatectomy with pelvic lymph node dissection. Pathology revealed Gleason score 4+5, pT3bN1 disease. At 1 month postoperatively, PSA increased to 13.6 ng/mL, and whole-body MRI detected a solitary right iliac bone metastasis that had not been identified preoperatively. (Intervention) Based on early recurrence, high Gleason grade, and good performance status, triplet therapy with androgen deprivation therapy, darolutamide, and docetaxel was initiated. (Outcome) PSA decreased to undetectable levels, and follow-up imaging demonstrated marked regression of the bone metastatic lesion. (Conclusion) This case highlights the clinical utility of whole-body MRI for detecting early metastatic recurrence after radical prostatectomy and suggests that early identification of occult metastasis may allow timely intensification of systemic therapy, including triplet therapy, in selected high-risk patients.