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Prostate Cancer Case Studies

Daniel P. Petrylak, MD: Efficacy Data's Role in Sequencing Therapies in mCRPC

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 although efficacy data are important, it is also important to assess the patient’s clinical condition, duration of hormonal response, as well as sites of disease before selecting the next treatment. What is important is to sequence these agents based on the sites of disease, Petrylak notes, visceral versus nonvisceral, symptomatic versus asymptomatic 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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