Charles J. Ryan, MD: Safety Considerations Regarding Treatment
Charles J. Ryan, MD
Published Online:Jun 18, 2015
Andrew S. is a 62-year-old real estate attorney from Tampa, Florida. He is an active golfer and church volunteer.
Metastatic Castration-Resistant Prostate Cancer Issue 2: Case 1
Metastatic Castration-Resistant Prostate Cancer Issue 2: Case 1
Metastatic Castration-Resistant Prostate Cancer Issue 2: Case 2
Dr. Ryan says that enzalutamide and abiraterone are both safe for long-term therapy. There is more corticosteroid toxicity with abiraterone during long-term therapy (>1.5 years), while with enzalutamide, fatigue and malaise can be present in the short term.
CASE 1: Metastatic Castration-Resistant Prostate Cancer
Andrew S. is a 62-year-old real estate attorney from Tampa, Florida. He is an active golfer and church volunteer.Patient underwent radical prostatectomy 4.5 years ago (at age 58 years).
- At diagnosis, the patient’s PSA level was 8.5 ng/mL and his Gleason score was 4+3 = 7; stage T1c
- Patient’s prior medical history is notable for prior smoking (quit 12 years ago), kidney stones, and hypertension (well controlled)
- Patient is currently on antihypertensives; liver function tests are normal
- Patient receives radiotherapy (64-70 Gy in standard fractionation) without androgen deprivation therapy
- Combined androgen blockade (CAB) initiated with an LHRH agonist and bicalutamide
- PSA nadirs at 0.65 ng/mL
- Side effects of CAB noted, including hot flashes and weight gain
- Testosterone is 20 ng/dL
- Patient is asymptomatic
- On CT scan, the prior LNs are unchanged
- Bone scan is positive for multiple lesions in the pelvis
- Bicalutamide is discontinued, and patient is enrolled in a clinical trial of an immunotherapy
