Prostate Cancer - Episode 12

Case 3: 72-Year-Old Man With mCRPC

November 19, 2019


Alicia Morgans, MD:Let’s move into case 3. This is a 72-year-old gentleman who started ADT [androgen deprivation therapy] and 6 cycles of docetaxel for metastatic disease. He was a Gleason score 8, with a PSA [prostate-specific antigen] of 40 [ng/mL] at the time. He had multiple bone metastases. He had a nadir PSA that was actually pretty good—at 0.1 ng/mL. His testosterone was at a castrate level of 39 [ng/dL] at that time, but continued on follow-up PSA testing. That initial treatment was in February of 2015. Follow-ups between June and August showed that his PSA was gradually rising—0.4 [ng/mL] in June; 1.6 [ng/mL] in July; and then in August, it was 33 [ng/mL], with a testosterone of 43 [ng/dL]. So, still castrate, but actually quite an increase in his PSA. His imaging at that time showed a new bone lesion. And importantly, he was still ECOG [performance status] 0. So, asymptomatic. He was really doing well.

At that time, because he had already had docetaxel in the metastatic hormone-sensitive or castrate-sensitive setting, he was started on abiraterone and prednisone. Really important actually, just to remind everybody: As we all know and we all think about, changing mechanism of action is going to be critical in our patient population to get the best outcomes. His nadir PSA at that time was 0.6 [ng/mL]. After about 6 months, he was having some fatigue and some belly pain. His PSA had gone up to 5 [ng/mL] at that point, and imaging showed 1 new bone lesion. His performance status [PS] was still good, with a PS of 1.

And so, I think this is our classic patient. He’s gotten metastatic castrate-sensitive treatment—docetaxel. He’s had first-line treatment for mCRPC [metastatic castration-resistant prostate cancer] with abiraterone, switching that mechanism. Now he’s progressing again. It seems like bone-only progression.

Transcript edited for clarity.