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Prostate Cancer Case Studies

Case Studies: Metastatic Castration-Resistant Prostate Cancer

Duane B. is a 61-year-old African-American man from Gainesville, Florida, who works as a truck driver for a medical supplies company.

Metastatic Castration-Resistant Prostate Cancer: Case 2

CASE 2: Metastatic Castration Resistant Prostate Cancer (mCRPC)

Duane B. is a 61-year-old African-American man from Gainesville, Florida, who works as a truck driver for a medical supplies company.

In January 2011, the patient presented to his PCP; his PSA was found to be 25.2 ng/mL and his prostate was enlarged on digital rectal examination; patient was referred to an oncologist for further evaluation.
  • Subsequent biopsy, CT, and bone scan showed prostate adenocarcinoma T2cN0M0, Gleason 5 (2+3), and the patient was considered intermediate risk
  • Patient received radical prostate-bed radiotherapy and full androgen deprivation therapy with subcutaneous goserelin (10.8 mg quarterly) and oral bicalutamide (50 mg daily); after approximately 18 months, the patient’s PSA had dropped to undetectable levels and the bicalutamide was discontinued in July 2012
  • Patient’s prior medical history is unremarkable except for prior tobacco use (quit smoking in 2005) and obesity; the patient is currently following a weight loss and exercise regimen
In April 2014, the patient returns to his PCP complaining of fatigue and intermittent pain in his hip and back and inability to work
  • Patient’s PSA level had increased to 15.3 ng/mL; his testosterone level was 29 ng/dL; bone scan showed the presence of multiple lesions in the lumbar vertebrae (L2 and L4) and in the hip
  • Zoledronic acid (every 3 weeks) was initiated for prevention of skeletal-related events
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