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

Case Studies: Optimal Use of Bone-Targeted Therapy for mCRPC

In this case-based interview, oncologist Nicholas J. Vogelzang, MD, FASCO, FACP; radiologist Rajan, Gupta, MD; and radiation oncologist Glen Gejerman, MD, discuss optimal therapeutic layering and multidisciplinary management of metastatic castration-resistant prostate cancer that progresses through multiple therapies. Practical perspective on the use of bone-targeted therapy to improve outcomes is emphasized.

Optimal Use of Bone-Targeted Therapy for mCRPC

November 2014

  • A 55-year old gentleman presented with nocturia and PSA level of 4.5 ng/mL
  • PMH: Insignificant 
  • DRE revealed an abnormal area of hardness
  • Biopsy showed adenocarcinoma of the prostate gland with a Gleason score 6 [3+3], clinical tumor stage T1c                                                                                                                                                                  
  • The patient remained on active surveillance

November 2015

  • When he returned after 1 year:
    • PSA, 10 ng/mL
    • Repeat biopsy showed Gleason 7 [4+3] with 8 of 12 cores positive
    • CT scan was negative for metastases
    • He remained asymptomatic
  • He was started on a 3-month depot injection of goserelin

February 2016

  • PSA, 34 ng/mL
  • CT scan was negative for metastases
  • He was started on abiraterone and prednisone
    • PSA declined to 15 ng/mL and remained stable
    • After 4 months, he developed cardiac arrhythmia attributed to prednisone; he was switched to enzalutamide
    • PSA remained stable

August 2016

  • 3 months following therapy switch, the patient complained of severe fatigue
    • CT scan showed enlarged lumbar spine and pelvic bone metastases
    • 18F-FDG PET showed increased FDG uptake in several areas of the lumbar spine and pelvis
    • PSA, 45 ng/mL
    • ALP, 225 U/I
  • Radium-223 therapy was initiated and enzalutamide was continued
  • After 4 cycles of radium-223:
    • Fatigue decreased significantly
    • PSA, 25 ng/mL
    • ALP, WNL
    • CT showed no new bone metastases
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