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Prostate Cancer Case Studies

Charles Ryan, MD: Comparison of Chemotherapy to a Secondary Hormone at the Time of Progression

Charles Ryan, MD
Published Online:Jul 19, 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


At the time of progression, would you go back to chemotherapy or use a secondary hormone?

One of the questions after patients have received chemotherapy for hormone-sensitive disease is whether to reinitiate chemotherapy in castration-resistant disease. I think that most of us feel that it is reasonable to reuse docetaxel in the setting of cRPC, but I don’t think there’s any evidence or even a strong bias towards going right back to chemotherapy at the time of progression. So this patient at 61 years old, wherever he is a couple of years after starting therapy, is probably going to be a reasonably good candidate for treatment with abiraterone or enzalutamide in this setting with chemotherapy as a backup.

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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