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

William Oh, MD: Follow-Up Recommendations During and After Treatment

William Oh, MD
Published Online:Jul 21, 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


What type of follow-up is needed for this patient during treatment and afterward?

Historically patients with metastatic prostate cancer would be followed after starting a treatment like leuprolide acetate every three months. As long as they were responding and their PSAs would go down, they may see the urologist or the oncologist while they get their injections, and that type of intensity was really because there was nothing else you could do except the androgen deprivation therapy.

In the setting of docetaxel for hormone-sensitive metastatic prostate cancer, we’re seeing these patients every three weeks obviously, because we’re giving them chemotherapy during that initial period in addition to androgen deprivation therapy. So we’re seeing them much more intensively.

After the 6 cycles of chemotherapy are done in a patient such as this, the question is, how often should you see them? Should you switch back to the every-three-months visit, or should you still maintain that level of follow-up? Typically for me it depends on what’s happening to the patient. We are following them more intensively after chemotherapy because chemotherapy is associated with a lot of side effects. So as long as they’re starting to recover, and as long as they’ve had an appropriate response to hormones in chemotherapy, I may start to transition to an every-three-months follow-up visit. Otherwise I may follow them more closely.

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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