Clinical Cases in Advanced Prostate Cancer - Episode 11

Case 2: 72-Year-Old Man With Metastatic CRPC

Jorge A. Garcia, MD, FA, describes the case of a 72-year-old man with metastatic castration-resistant prostate cancer.

Jorge A. Garcia, MD, FACP: Our next case is a patient with metastatic castration-resistant prostate cancer. This case is a 72-year-old gentleman in February 2015. He started ADT [androgen deprivation therapy] and docetaxel secondary to a high-volume de novo metastatic disease. At the time, he had a T3N1M1 disease with a Gleason score of 8 and a PSA [prostate-specific antigen] of 40 ng/mL. He had multiple bone metastases, and you can see his bone scan right there. Using the ECOG definition for high-volume disease, he had more than 4 bone lesions, 2 of which were outside the appendicular skeleton. He again initiated ADT and docetaxel-based chemotherapy. He completed 6 cycles of therapy. His nadir PSA was 0.1 ng/mL, and he was castrated with a testosterone level of 39 ng/dL.

He had further testing in June 2015, which showed that his PSA was 0.4 ng/mL and already increasing. In July 2015, his PSA had gone up to 1.6 ng/mL. A couple of years later, in August 2017, his PSA was 33 ng/mL and his testosterone was castrate at 43 ng/dL. His bone scan again met definition for prostate cancer guidelines with 2 new bone lesions compared with the initial bone scan. He had a rising PSA and new bone metastases after having received up-front ADT and docetaxel-based chemotherapy based on the ECOG data.

At the time, the patient went on to receive abiraterone acetate and prednisone. His PSA on this adrenal biosynthesis inhibitor went down to 0.6 ng/mL. However, 6 months later, he reported mild fatigue, had some abdominal pain, and his PSA was already up in the 5-ng/mL range. His bone scan demonstrated 1 new bone lesion. As you can see, his CT scan of the chest, abdomen, and pelvic region demonstrated 2 small liver lesions, and you can see the big 1 anteriorly. His functional capacity was still pretty decent, and he had an ECOG performance status of 1.

Transcript edited for clarity.