A 66-Year-Old Man With Metastatic Castrate-Sensitive Prostate Cancer

Case: A 66-Year-Old Male with Metastatic Castrate-Sensitive Prostate Cancer

Initial presentation

• A 66-year-old man presented with mild intermitted back pain
• PMH: DM; medically controlled; OTC analgesics for pain
• FH: No known family history of cancer
• PE: DRE revealed an enlarged prostate; otherwise unremarkable
  
  

Clinical Workup

• PSA 70 ng/mL
• Core needle biopsy with TRUS showed adenocarcinoma of prostate
  • Gleason score (4+4)
• Bone scan revealed 4 spinal lesions (T8/T9, L1/L2) and 1 in the right femur
• Chest/abdominal/pelvic CT scan was negative for distant metastases
• Diagnosis: stage IV mCSPC
• ECOG PS 1
   

Treatment and Follow-Up

• He was started on ADT + apalutimide 240 mg qDay
• At 2-month follow up: PSA 10 ng/mL
• No new lesions on repeat imaging