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Prostate Cancer Case Studies

Daniel P. Petrylak, MD: Frontline Chemotherapy in CRPC

Daniel P. Petrylak, MD
Published Online:May 26, 2015
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



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 since this patient is symptomatic, he would initiate chemotherapy upfront as the first treatment. Hormonal therapy could also be utilized in the frontline setting.

There’s no absolute right or wrong answer, Petrylak notes. In a rapidly progressing symptomatic patient, docetaxel is commonly utilized first, rather than waiting. There are also combination trials that are available in phase I that show that you can safely combine abiraterone with docetaxel, but that’s not yet an approved strategy.

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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