Prostate Cancer - Episode 6

Case 2: 64-Year-Old White Male With mCSPC


Alicia Morgans, MD:Let’s move on to our next case.

Jorge Garcia, MD:Great, Alicia, thank you.

This is a 64-year-old white man who, in May 2018, was referred to urology with some urinary tract symptoms—specifically urinary hesitancy, decreased urinary flow, and some intermittent back pain usually relieved with over-the-counter NSAIDs [nonsteroidal anti-inflammatory drugs]. His PSA [prostate-specific antigen] at the time was found to be elevated at around 130 ng/mL. His family history: He had CHF [congestive heart failure], heart disease, and hypertension. His rectal exam at the time was a firm gland, but no masses or nodules were found.

He finally undergoes a 12-core sextant biopsy and has high-volume disease. Ten of 12 cores with positive disease, with a Group 4 or a Gleason 4+4. He undergoes a CT [computed tomography] scan of the abdomen and pelvic region and is found to have multiple lymph node metastases, specifically retroperitoneal lymphadenopathy—the largest, 2.5 cm. A technetium bone scan also demonstrated the presence of multiple bone lesions in the axial skeleton, sacrum, ribs, left femur, and scapula. And his ECOG performance status was 1.

So really, this is a guy who is walking in the office with de novo metastatic disease. Whatever definition one follows, whether you use the French or the American definition, he does have high-volume disease.

Transcript edited for clarity.