Case: A 69-Year-Old Man With mCRPC Progressing on Therapy
July 2016
H&P:
- A 69-year old gentleman presented with nocturia
- PMH: unremarkable
- DRE, enlarged prostate
- PSA, 50.3 ng/mL
- TRUS and biopsy showed adenocarcinoma of the prostate gland; Gleason score 8 [4+4]
- CT scan showed minimal nodal involvement
Treatment:
- Started on ADT with initial PSA response - 15 ng/ml August 2016
March 2017
8 months later, patient complained of fatigue and mild back discomfort
- Imaging with CT and bone scan showed two metastatic bone lesions (1 spine, 1 pelvis)
- PSA, 25 ng/mL
- Hb, 9.0 g/dL
- ANC, 1.7
Treatment:Enzalutamide
- Initial PSA response 10 mg/ml but rising over one year later continued
March 2018
- PSA 30 ng/ml
- CT showed 4 bone metastases (2 spine, 2 pelvis) and diffuse liver lesions
April 2018
- Radium-223 initiated, patient received 6 injections
April 2019
One year later patient presented with increased lower back discomfort causing disruption in daily activity.
- CT showed new lymphadenopathy and diffuse liver lesions
- PSA 45 ng/mL
- Hb, 9.0 g/dL
- ANC, 1.6
- Treatment: Patient started on docetaxel, 6 cycles completed; achieved stable disease (Hb, 14.1 g/dL)