The Community Resource in Targeted Therapies
Driving Knowledge. Empowering Change. Optimizing Outcomes.
ONCAlert | Upfront Therapy for mRCC
Prostate Cancer Case Studies

Charles Ryan, MD: Follow-Up Recommendations During and After Treatment

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


What type of follow-up is needed for this patient during treatment and afterward?

This is a patient who I would probably see every three weeks while he’s getting chemotherapy. I would give him 6 cycles of chemotherapy, so we would be seeing each other quite a bit right at the outset of treatment. Following the completion of chemotherapy, we would reassess the situation. I would hope that his PSA would be down, his performance status would be good. If there are soft tissue elements, I may consider repeating a CT scan after the completion of chemotherapy. I don’t always repeat a bone scan because, in many cases, they can be quite confusing because of issues around bone scan flare and things like that. Once this patient has completed chemotherapy, provided that he is symptomatically well and his PSA is down and things look good, I might only see him every three months for a period of time.

One of the questions that comes up in a situation like this is local therapy. This is a person who presented to his physician at 61 years-old with a primary tumor that was very symptomatic. He was having lower urinary tract symptoms and even some hematuria. This is the type of patient who may benefit, in a palliative sense, from receiving local therapy, which might reduce his risk, for example, of pain or further hematuria. It might reduce his risk of further progression in the prostate which could lead to urinary retention or even kidney failure. For those situations, I think a discussion around local therapy is reasonable.

There are many situations in oncology where local therapy, even in the face of metastatic disease, may provide some sort of a survival benefit and long-term disease control benefit. We haven’t proven that in prostate cancer. There are some studies open. We are participating in a study where we are randomizing patients to local therapy or no local therapy at this point after they’ve completed the chemotherapy. Outside of a clinical trial I would only take it on a case-by-case basis, and if the patient were completely asymptomatic and did not have any issues related to enlargement of the prostate or things like that that could benefit from local therapy, I probably wouldn’t offer it to him. But we do await final data on that.

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

 

Publications
Copyright © TargetedOnc 2018 Intellisphere, LLC. All Rights Reserved.