A 69-Year-Old Man With Advanced Castrate-Resistant Prostate Cancer

May 19, 2020

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.

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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