Case Review: Rationale and Methods in mCRPC

Video

Evan Y. Yu, MD, discusses the case and subsequent palliative treatment plan for a patient with metastatic castration-resistant prostate cancer.

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
Recent Videos
1 expert in this video
1 expert in this video
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Related Content