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Prostate Cancer Case Studies

Case Studies: Therapeutic Approach for Nonmetastatic Prostate Cancer

In this case-based interview, Charles Ryan, MD, provides an overview on the therapeutic approach for a 62-year-old male patient with nonmetastatic castration-resistant prostate cancer.

Therapeutic Approach for Nonmetastatic Prostate Cancer

January 2014

  • A 66-year old retired African American male presents with reduced urinary flow and hematuria.
  • PMH: High blood pressure. Currently taking enalapril 10 mg.
  • FHx: Father lung cancer – age 74.
  • Patient walks 3 miles a day.
  • PSA 9.8 ng/ml
  • Prostate biopsy shows Gleason 7 (4+3) prostate cancer
  • Undergoes robotic-assisted laparoscopic prostatectomy (RALP) and pelvic lymph node dissection (PLND)
  • Results show:
    • pT3b (focal extracapsular extension and seminal vesicle invasion) – margins negative
    • N1
    • M0
  • Post-operative PSA=0.64 ng/ml
  • Patient undergoes adjuvant radiation therapy and is started on leuprolide acetate.
  • PSA drops to undetectable levels

January 2016

  • PSA starts to rise to 0.3 ng/ml
    • Repeated 3 months later – 0.7 ng/ml
    • Bone scan and prostate-specific membrane antigen (PSMA) scan both negative
    • Diagnosis nonmetastatic castration-resistant prostate cancer (CRPC)
    • Patient declines additional therapy at this time

November 2017

  • PSA continues to rise over the next 18 months going up to 9.8 ng/ml
  • Bone scan shows lesion in the left superior pubic ramus
  • Patient is asymptomatic
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