His options are sipuleucel-T3 cycles over 4 to 6 weeks. Abiraterone 1000 mg orally once daily plus prednisone 5 mg orally twice daily or enzalutamide 160 mg orally once daily. Observation until he becomes symptomatic is an option. Chemotherapy (docetaxel) is approved by the US Food and Drug Administration (FDA) for use in patients like Bernie, but it is not common to use at this point.

Judd W. Moul, MD, FACS: Options to Control Recurrent Metastatic Disease

Judd W. Moul, MD, FACS: Chemotherapy Consideration

Dr. Crawford would recommend that he start on either abiraterone or enzalutamide. When he shows signs of progression, Dr. Crawford would add chemotherapy. There are good data that men with mCRPC maintain a response to chemotherapy after failing these other agents.

E. David Crawford, MD: Options to Control Recurrent Metastatic Disease

E. David Crawford, MD: Safety and Tolerability Issues

Bernie presents with NCCN intermediate-risk prostate cancer. He did very well with the initial therapy; however, a pelvic lymph node signaled recurrence of the disease. This lymph node was likely involved when he had his initial treatment. It took nearly 7 years for it to become detectable both by CT scan and by an elevated PSA level. Had Bernie chosen a radical prostatectomy, a lymph node dissection would likely have identified microscopic disease. Bernie had a second good response to hormonal therapy; however, over the ensuing several years, castrate-resistant disease evolved. The next test that would influence his treatment would be a bone scan. Stratification of men with prostate cancer into risk groups is essential to guide management.

Metastatic Prostate Cancer: Case 1

Judd W. Moul, MD, FACS: Options to Control Recurrent Metastatic Disease

Judd W. Moul, MD, FACS: Chemotherapy Consideration

E. David Crawford, MD: Options to Control Recurrent Metastatic Disease

E. David Crawford, MD: Safety and Tolerability Issues

E. David Crawford, MD: Influences on Treatment Options

E. David Crawford, MD: Chemotherapy Consideration