ONCAlert | 2018 SGO Annual Meeting on Women’s Cancer
Prostate Cancer Case Studies

William Oh, MD: Biggest Considerations for Elderly Patient Population

William K. Oh, MD
Published Online:Jul 13, 2016
Stanley S is an 83-year-old Caucasian male whose past medical history includes diagnosis of adenocarcinoma of the prostate in 2012 with no evidence of metastasis.

Metastatic Prostate Cancer with Charles Ryan, MD and William K. Oh, MD: Case 1

Metastatic Prostate Cancer with Charles Ryan, MD and William K. Oh, MD: Case 1
Metastatic Prostate Cancer with Charles Ryan, MD and William K. Oh, MD: Case 2


What are the biggest considerations and concerns in an elderly patient?

Prostate cancer is a disease of older men. We know in general that patients are going to have other comorbidities and a man in his 80s with symptomatic progressive castration-resistant prostate cancer (CRPC) is not an uncommon scenario. Obviously all 80-year-old men are not exactly the same, so some are more functional and more sick than others. So we have to kind of balance and personalize the treatment for each man independent of their age. But that said, he is symptomatic from his cancer. We don’t know a lot about other comorbid illnesses in this particular patient, so we don’t really know whether his age would limit us in any way from therapeutic options. I would assume, based on this case scenario as we hear it, that he’s really a candidate for any of the known treatments for metastatic castration-resistant prostate cancer.

CASE: Metastatic Prostate Cancer (Part 1)

Stanley S is an 83-year-old Caucasian male whose past medical history includes diagnosis of adenocarcinoma of the prostate in 2012 with no evidence of metastasis. At the time, he was started on bicalutamide and his serum PSA levels subsequently decreased to 1.2 ng/ml.

During his most recent follow-up exam, the patient complained of intermittent back pain and increasing fatigue.  

  • His serum PSA level is 56.9 ng/ml and his alkaline phosphatase is 258 U/L
  • CT scan shows enlarged lumbar bone metastasis with associated soft tissue component, as well as symptomatic nodes with lumbar bone metastases
  • Biopsies of the prostate and transrectal ultrasound reveal the prostate is 42 grams
  • Ten of 14 cores are positive for prostate cancer for a Gleason score of 8 (4 + 4)
  • His ECOG performance status score is a 2

 

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