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|Videos|May 19, 2020
A 69-Year-Old Man With Advanced Castrate-Resistant Prostate Cancer
Author(s)Jorge A. Garcia, MD, FACP
Jorge Garcia, MD, FACP, provides insight on the case of a 69-year-old man with mCRPC and assesses the classes of agents currently available as treatment options.
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Case:A 69-Year-Old Man with Advanced Castrate Resistant Prostate Cancer
Initial presentation
- A 69-year-old man presented with intermittent back discomfort and loss of appetite
- PMH: hyperlipidemia controlled on a statin, no known family history of cancer
- PE: DRE revealed asymmetric, boggy prostate; otherwise unremarkable
Clinical Workup
- Biopsy with TRUS showed adenocarcinoma of prostate
- Stage T2N0M0
- Grade group 4
- Germline genetic testing: MLH1, MSH2, MSH6, PMS2, BRCA1/2, ATM, PALB2 and CHEK2
- Chest/abdominal/pelvic CT scan showed no evidence distant metastases or lymph node involvement
- Bone scan was negative
- PSA 24.9 ng/mL
Treatment and Follow-Up
- EBRT + ADT was started
- Follow up at 6 months, PSA 11.2 ng/mL
- At 12 months PSA 18.6 ng/mL
- Patient reported increasing back discomfort and difficulty walking
- Bone scan at that time showed multiple vertebral lesions at L3/L4
- Treatment with radium-223 dichloride was initiate
- 6 infusions were completed, treatment was well tolerated
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