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Prostate Cancer Case Studies

Daniel P. Petrylak, MD: Pre-Chemo mCRPC Treatment

Daniel P. Petrylak, MD
Published Online:May 26, 2015
Robert C. is a 63-year-old physical education teacher and high school wrestling coach from Savannah, Georgia

Metastatic Castration-Resistant Prostate Cancer: Case 1

Daniel P. Petrylak, MD, Professor of Medicine (Medical Oncology) and of Urology, Professor and Co-Director, Signal Transduction Research Program, Yale Cancer Center, explains that studies are beginning to look at whether patients will respond to multiple hormonal manipulations or whether they should receive radium-223 before chemotherapy. Petrylak admits that sequencing therapies is starting to get complex; however, he reiterates that the best treatment depends on the site of disease.

CASE 1: Metastatic Castration-Resistant Prostate Cancer (mCRPC)

Robert C. is a 63-year-old physical education teacher and high school wrestling coach from Savannah, Georgia

In May 2007, patient presented to his PCP and received routine screening for prostate cancer.
  • Patient’s PSA level was 6.2 ng/mL
  • Digital rectal examination and subsequent CT scan revealed the presence of prostate adenocarcinoma T2bN0M0, Gleason 6 (2+4), classified as intermediate risk
  • Patient underwent radical prostatectomy and adjuvant radiotherapy in June 2007
  • Patient’s prior medical history is notable for abdominal aortic aneurysm surgery in 2002 and hypertension (well controlled on current therapy)
  • His liver function tests were unremarkable
In July 2010, after approximately 3 years, the patient returned to his PCP for a routine physical, and an increase in PSA to 9.7 ng/mL was detected; he was asymptomatic.
  • Bone scan in August 2010 was negative
  • Androgen deprivation therapy (ADT) was initiated in August 2010 with goserelin; the patient’s PSA subsequently decreased to 0.5 ng/mL
In September 2012, after approximately 2 years, the patient’s PSA began to rise to 2.0 ng/mL; testosterone level was 19 ng/dL
  • Oral bicalutamide was added to his ADT; he continued to be asymptomatic
In April 2013, the patient presented to his PCP complaining of lower back pain and moderate to severe fatigue; his PSA had increased to 3.7 ng/mL
  • Bone scan revealed the presence of diffuse bone lesions in the lumbar and sacral vertebral bodies
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