A 67-Year-Old Man With Metastatic Castrate-Sensitive Prostate Cancer

Case: A 67-Year-Old Male with Metastatic Castrate-Sensitive Prostate Cancer

Initial presentation

• A 67-year-old active man presented with intermittent back pain and loss of appetite
• PMH: unremarkable
• FH: the patient’s father suffered a myocardial infarction at age 69; paternal grandmother had dementia; no known family history of cancer
• PE: DRE revealed asymmetric enlarged prostate; PE otherwise unremarkable
  
  

Clinical workup

• Core needle biopsy with TRUS showed adenocarcinoma of prostate
  • Stage T2N0M1b
  • Grade group 3
• Bone scan reveal 3 spinal lesions (T10, L2, L3) and 1 near the left iliac crest
• Abdominal and pelvic CT scan showed no other organ metastases
• PSA 24.9 ng/mL
  
  

Treatment and Follow-Up

• The patient was counselled on treatment options; he expressed concern regarding long-term AR exposure
• DOCE + ADT was initiated, 6 cycles were well-tolerated; PSA 6.2 ng/mL
• 2-year follow-up PSA 10.8 ng/mL; continued treatment regimen
  • 5 months later he reported increasing back pain and difficulty walking
  • PSA 21.4 ng/mL
  • PSADT 5.1 months
  • No new bone lesions on imaging
• Abiraterone 1000 mg PO qDay + prednisone 5 mg PO q12hr was initiated
• 1 year later PSA 30.2 ng/mL
  • Abdominal/pelvic CT showed multiple new small liver lesions, 1 new vertebral lesion and 1 new appendicular lesion
• Treatment with cabazitaxel 20 mg/m2 IV q3W + prednisone 10 mg PO qDay was initiated