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Prostate Cancer Case Studies

William Oh, MD: Bone-Targeted Therapy

William Oh, MD
Published Online:Jul 21, 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


Would you consider bone-targeted therapy for this patient, and why?

This patient presented with metastatic prostate cancer to the bone. Traditionally we would add bone-targeted treatments in this type of setting. By bone-targeted treatments I mean bisphosphonates or RANK ligand inhibitor, drugs such as zoledronic acid, or denosumab. In hormone-sensitive prostate cancer patients, the evidence of benefit has never really been clearer, and, in fact, two large studies have not suggested that there’s a significant benefit to starting these treatments in the hormone-sensitive state. However, I do evaluate these patients in various ways.

I do bone density tests because if a patient is osteopenic or osteoporotic, I think they may benefit from a drug like denosumab in this setting, simply to prevent progression of their osteopenia or osteoporosis. It may also have a long-term benefit in terms of their skeletal related events. But for the most part, drugs like zoledronic acid or denosumab are not indicated in hormone-sensitive prostate cancer. They’re clearly indicated in castration-resistant metastatic disease.

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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