ONCAlert | 2017 San Antonio Breast Cancer Symposium
George Gupta Mcrpc Case Studies

Case Studies: mCRPC Treated with Concomitant ADT and Radium-223 Therapy

In this case-based interview, oncologist Dan George, MD, discusses the management of a patient who develops prostate cancer bone metastases. Radiologist Rajan Gupta, MD, and radiation oncologist Glen Gejerman, MD, share viewpoints on the use of imaging and bone-targeted therapy for this patient.

mCRPC Treated with Concomitant ADT and Radium-223 Therapy

December 2012

  • A 65-year old gentleman presented to a urologist with urinary incontinence
  • Digital rectal examination was unremarkable
  • Serum prostate-specific antigen (PSA) level of 10.8 ng/mL
  • Transrectal ultrasound and biopsy revealed adenocarcinoma of the prostate gland with Gleason score 7(3 + 4)
  • Bone scan and CT showed no evidence of metastasis
  • The patient opted for radical prostatectomy; pathology confirmed Gleason 7 prostate cancer with evidence of extracapsular extension and negative nodes; pT3aN0
  • Immediately following surgery, his PSA level was undetectable (<0.1 ng/mL)

December 2014

  • Two years later the patient developed disease progression
    • PSA level increased rapidly to 15 ng/mL
    • He was asymptomatic
  • He was referred to an oncologist by his urologist
  • Bone scan and CT were negative
  • He was started on androgen deprivation therapy and had an initial response of PSA decline to 0.5 ng/mL

December 2015

  • Over the next year, his PSA level increased to 35 ng/mL
  • Repeat imaging studies were done:
    • Bone scan showed multiple boney metastases in the spine, pelvis, ribs, and femur
    • CT scan showed no visceral or nodal disease
  • Within 3 months his PSA level rose to 145 ng/dL and he began complaining of fatigue and pain
  • He was started on abiraterone and prednisone
  • Additionally, he opted for therapy with radium-223
  • After 3 infusions of radium-223 his PSA declined to <10 ng/dL; ALP remained stable
  • After 6 cycles of treatment, CT and bone scan confirmed stable disease with no new metastases
  • The combination was generally well tolerated; the patient experienced grade 2 anemia and fatigue
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