A 76-Year-Old Man With Recurrent Castrate-Sensitive Prostate Cancer
Nicholas Vogelzang, MD, FASCO, FACP, comments on managing an elderly patient with hormone-sensitive prostate cancer with apalutamide and ADT based on data demonstrated by the phase 3 TITAN trial.
Case: A 76-Year-Old Male With Recurrent Castrate-Sensitive Prostate Cancer
History
- A 76-year-old man diagnosed with localized prostate cancer, 4 years ago
- At that time, he underwent EBRT
Currently
- Patient was lost to follow-up; returns due to intermittent hip pain
- PMH: obese, BMI 32; prostate cancer; otherwise unremarkable
- FH: No known family history of cancer
- PE: left hip tender to palpation, slight limp and evidence of decreased weight bearing on left lower limb
Clinical workup
- PSA 10 ng/mL; doubling time 3 months
- Core needle biopsy with TRUS showed adenocarcinoma of prostate
- Gleason score (4+4)
- Bone scan revealed 2 bone metastases: 1 in the left femur 1 in the left pelvis
- Chest/abdominal/pelvic CT scan positive for 4 pelvic lymph node metastases
- Diagnosis: stage IV mCSPC
- ECOG PS 1
Treatment and Follow-Up
- He was started on ADT + apalutimide 240 mg qDay
- At 3-month follow up: PSA 2 ng/mL
- Repeat imaging showed no new lesions
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