During a virtual event, Thomas Martin, MD, and participants considered the use of the on-body injector for subcutaneous isatuximab for a frail patient with transplant-ineligible newly diagnosed myeloma.
|Videos|June 17, 2020
A 67-Year-Old Man With Metastatic Castrate-Sensitive Prostate Cancer
Author(s)Charles Ryan, MD
Expert perspectives on the identification and management of metastatic castrate-sensitive prostate cancer in a 67-year-old man.
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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
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