Hormone Sensitive Metastatic Castration-Resistant Prostate Cancer - Episode 1
Nicholas J. Vogelzang, MD, FASCO, FACP:This is a 76-year-old man who presented with urinary outflow symptoms and back pain to his urologist. He had a digital rectal exam showing a clearly abnormal rectala T3 or T4; the urologist referred him for biopsy, which revealed a Gleason grade group 4, or what we call a grade group 4—Gleason 8 prostate cancer in 9 of 12 cores. Preoperatively his PSA [prostate-specific antigen] was 85. His testosterone was noncastrate at 300. He had a bone scan and a CT scan showing multiple bone metastases and no soft tissue or lymph node involvement.
Using the data from STAMPEDE and LATITUDE trials, the patient was treated with LHRH [luteinizing hormone-releasing hormone] agonist therapy and abiraterone. The patient had a dramatic PSA and clinical and symptomatic response; his PSA dropped to undetectable. He felt very well, and as expected his testosterone also progressed to a very low level. This response lasted for about 3 years, and then at around that time his PSA began to slowly climbinitially from a 0.1 to 0.2, then with a doubling time of about 3 to 4 months—ultimately reaching a level of around 5, after which he became slightly symptomatic: His appetite was decreasing and fatigue increasing; he didn’t describe bone pain per se, but he did say, “Well, I’m needing a little bit more aspirin or Advil,” and I started to talk to him about stopping abiraterone and moving on to radium-223 [dichloride; Xofigo].
Transcript edited for clarity.
Hormone Sensitive mPC progressing to mCRPC