From the Ptolemy Theorem, we have the product of diagonals equals the sum of the products of the opposite sides for any cyclic quadrilateral.
So, in our case, we have the following identity from the Ptolemy Theorem:
$PR \cdot QS=ac+bx$---(1)
In order to get rid of the variables $PR$ and $QS$, we have to relate them to the variables $a, b, c, x$ and this can be done by observing there are two right-angle triangles exist in the diagram since PS is the diameter of the cicle, so by applying the Pythagoras' Theorem to each of these triangles we get:
$PR^2=x^2-c^2$ and $QS^2=x^2-a^2$
Hence, raise the equation (1) to the second power and replace the two equations above into it gives