Case Based Peer Perspectives: Metastatic Castration-Resistant Prostate Cancer

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Case Based Peer Perspectives: Metastatic Castration-Resistant Prostate Cancer

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)
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