Case Review: Rationale and Methods in mCRPC

Case: A 66-Year-Old Man with Metastatic Castration-Resistant Prostate Cancer

Initial presentation

• A 66-year-old man presented with increasing difficulty walking and sleeping on his back due to lower back and hip discomfort
• PMH: hypertension, medically controlled; no known family history of cancer
• PE: DRE revealed a nodular prostate; otherwise unremarkable
  
  

Clinical workup

• Biopsy with TRUS showed adenocarcinoma of prostate
  • Stage T2N0M0
  • Grade group 4
  • Expected survival > 5 years
• Germline testing: MLH1, MSH2, MSH6, PMS2, BRCA1/2, ATM, PALB2 and CHEK2
• Chest/abdominal/pelvic CT scan showed no evidence distant metastases or lymph node involvement
• Bone scan was negative
• PSA 26 ng/mL
  
  

Treatment and Follow-Up

• EBRT for 8 weeks + neoadjuvant concurrent, and adjuvant ADT for 2 years
• At 6 months post-ADT follow-up; PSA 5.9 ng/mL
• At 12 months follow-up:
  • Patient reported continued back discomfort, difficulty walking and loss of appetite
  • PSA 16 ng/mL
  • Bone scan showed multiple lesions in the right femur and pelvis
  • Abiraterone + ADT was initiated for 1 year
• At subsequent follow-up:
  • Patient complained of increased bone pain in right femur
  • PSA 18.6 ng/mL
  • Abiraterone was ceased; ADT continued
  • Treatment with radium-223 dichloride was initiated; 6 infusions completed and well-tolerated at post-infusion follow-up