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Prostate Cancer Case Studies

Case Studies: Hormone Sensitive Metastatic Castration-Resistant Prostate Cancer

Nicholas J. Vogelzang, MD, FASCO, FACP, reviews the case of a hormone-sensitive patient with metastatic castration resistant prostate cancer (mCRPC) and discusses possible treatment options, with consideration to the ERA 223 and PEACE 3 trials.

Hormone Sensitive Metastatic Castration-Resistant Prostate Cancer

Hormone Sensitive mPC progressing to mCRPC

March 2015

H&P:

  • A 76-year old gentleman presented to his urologist with nocturia and lower back pain
  • PMH:  unremarkable
  • Digital rectal examination revealed an abnormal area of hardness

Imaging:

  • Transrectal ultrasound and biopsy revealed adenocarcinoma of the prostate gland with a Gleason score 8 [4+4] with 9 of 12 cores positive
    • PSA, 85.3 ng/mL
    • Testosterone, 300 ng/dL (confirm with Dr. Vogelzang)
  • CT scan showed multiple metastases of the spine

He was started on abiraterone + prednisone + goserelin (per LATITUDE and STAMPEDE studies)

PSA and testosterone level continued to decline over the next 2 years to PSA, 0.1 ng/ml; testosterone <3 ng/dL.  (confirm testosterone with Dr Vogelzang)

 

March 2018

  • After 3 years of therapy patient reported increasing fatigue
  • PSA and testosterone levels began to rise
    • PSA increased from 0.5 ng/ml  to 1.0 ng/ml; 2.0 ng/mg to 4.8 ng/ml at 2-3 month intervals
    • Testosterone, <3 ng/dL
    • CT scan shows several new bone metastasis; others improved
  • Patient is diagnosed as castration resistant and abiraterone + prednisone was discontinued
  • Radium-223 therapy was initiated
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