ONCAlert | 2017 San Antonio Breast Cancer Symposium
Prostate Cancer Case Studies

Charles Ryan, MD: Bone-Targeted Therapy

Charles Ryan, MD
Published Online:Jul 19, 2016
Mathew J is a 61 year old African American male who presented to his primary care physician with lower urinary tract symptoms, including sporadic hematuria. He complains of abdominal pain and low back pain starting four months ago and increasing in frequency.

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

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


Would you consider bone-targeted therapy for this patient, and why?

Bone-targeted therapy for a newly diagnosed patient with metastatic disease is a little bit controversial. There have been studies done both in the US and in the UK with zoledronic acid. The UK study, which was recently reported, actually seemed to suggest that there may be a potential benefit. That’s a little controversial because in one UK study that looked at zoledronic acid there was no benefit. But one that was published recently that looked at zoledronic acid plus celecoxib seemed to suggest that there is a benefit. We’re waiting for sort of confirmation on that point. In the US, zoledronic acid was not shown to lead to a significant disease control benefit or a survival benefit when added to early hormonal therapy. So, for the most part in these cases, I’m not using a bone-targeted therapy. If a patient has a bone event, a fracture, a spinal cord compression, or some type of a very clinically significant bone event where they may be at risk for continued bone events, I would be more likely to use it earlier in the clinical course. But, for a standard patient who has bone metastasis that are not symptomatic and there hasn’t been a bone event, I think it’s reasonable to not use a skeletal-targeted therapy.

CASE: Metastatic Prostate Cancer (Part 2)

Mathew J is a 61 year old African American male who presented to his primary care physician with lower urinary tract symptoms, including sporadic hematuria. He complains of abdominal pain and low back pain starting four months ago and increasing in frequency. Prior medical history includes non-insulin dependent diabetes mellitus, well-controlled on metformin since 2006. The patient was referred to urology for further evaluation. ng/ml.

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

  • Digital rectum exam revealed nodular prostate /L
  • Serum PSA level; 129 ng/ml
  • Alkaline phosphatase, 258
  • TRUS/prostate biopsy: 53 gram prostate, 12/12 cores (+), Gleason 4 + 5
  • CT indicates blastic lesions to lumbar spine and pelvis
  • Bone Scan positive for T/L spine, pelvis, right femur, scapula
  • ECOG performance status, 1

 

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