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Prostate Cancer Case Studies

Charles J. Ryan, MD: Treatments to Prolong Survival

Charles J. Ryan, MD
Published Online:Jun 18, 2015
Jerry K. is a 66-year-old Cuban American from San Diego, California, who works as a freelance IT consultant and systems analyst in the hospitality industry.

Metastatic Castration-Resistant Prostate Cancer Issue 2: Case 2


Dr. Ryan lists abiraterone, enzalutamide, docetaxel, radium-223, and cabazitaxel as the standard options for this patient. 

CASE 2: Metastatic Castration-Resistant Prostate Cancer

Jerry K. is a 66-year-old Cuban American from San Diego, California, who works as a freelance IT consultant and systems analyst in the hospitality industry.

In January of 2009, he underwent a prostate biopsy after his PSA increased from 1.0 ng/mL (1/06) to 1.2 ng/mL (2/07) to 29.1 ng/mL (12/08).
  • Adenocarcinoma (Gleason score 4+4 = 8) detected in 7 of 10 cores; stage T1c
  • Prior medical history is notable for arthroscopic rotator cuff repair in 2006 with infectious complication requiring hospitalization
  • Patient is asymptomatic with good performance status (ECOG 0); taking no medications and liver function tests are within normal limits
  • Initial therapy included androgen deprivation therapy (ADT) with bicalutamide and an LHRH agonist along with 78 Gy of radiation
  • After 14 months of ADT, PSA decreased to a nadir of 0.20 ng/mL
  • Patient experiences periodic hot flashes
While on ADT, PSA increases to 1.0 ng/dL
  • Serum testosterone levels are castrate (20 ng/dL)
  • Bicalutamide is withdrawn; LHRH therapy is continued
After 26 months of ADT, the patient’s PSA increased to 5.0 ng/mL with a PSA doubling time of 4 months; patient complains of fatigue, periodic hot flashes, and intermittent lower back pain
  • Bone scan reveals several nodules in the L5 vertebra
  • Patient receives immunotherapy with sipuleucel-T for minimally symptomatic metastatic castrate-resistant prostate cancer
  • Denosumab initiated for skeletal metastases
At current visit (3.5 months after sipuleucel-T), patient presents with worsening back pain and radiographic evidence of progression.
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