Metastatic Castration-Resistant Prostate Cancer: Case 2 - Episode 7
Daniel P. Petrylak, MD, Professor of Medicine (Medical Oncology) and of Urology, Professor and Co-Director, Signal Transduction Research Program, Yale Cancer Center, suggests that a bone antiresorptive agent such as denosumab or zoledronic acid, should be considered for men with metastatic castration-resistant prostate cancer.
If the patient progresses on primary docetaxel, one could consider going on another hormonal agent. If he hasn’t received isotopes, radium-223 is also approved in that particular setting. You could also consider cabazitaxel if the patient fails primary chemotherapy.
CASE 2: Metastatic Castration Resistant Prostate Cancer (mCRPC)
Duane B. is a 61-year-old African-American man from Gainesville, Florida, who works as a truck driver for a medical supplies company.
In January 2011, the patient presented to his PCP; his PSA was found to be 25.2 ng/mL and his prostate was enlarged on digital rectal examination; patient was referred to an oncologist for further evaluation.
Subsequent biopsy, CT, and bone scan showed prostate adenocarcinoma T2cN0M0, Gleason 5 (2+3), and the patient was considered intermediate risk
Patient received radical prostate-bed radiotherapy and full androgen deprivation therapy with subcutaneous goserelin (10.8 mg quarterly) and oral bicalutamide (50 mg daily); after approximately 18 months, the patientâ€™s PSA had dropped to undetectable levels and the bicalutamide was discontinued in July 2012
Patientâ€™s prior medical history is unremarkable except for prior tobacco use (quit smoking in 2005) and obesity; the patient is currently following a weight loss and exercise regimen
In April 2014, the patient returns to his PCP complaining of fatigue and intermittent pain in his hip and back and inability to work
Patientâ€™s PSA level had increased to 15.3 ng/mL; his testosterone level was 29 ng/dL; bone scan showed the presence of multiple lesions in the lumbar vertebrae (L2 and L4) and in the hip
Zoledronic acid (every 3 weeks) was initiated for prevention of skeletal-related events