A 75-Year-Old Man With Metastatic Castrate-Resistant Prostate Cancer

March 24, 2020

A 75-Year-Old Man With Metastatic Castrate-Resistant Prostate Cancer


Case: A 75-Year-Old Male with Metastatic Castrate-Resistant Prostate Cancer

Initial presentation

2015

  • A 75-year-old man presented with intermittent right hip pain and decreased appetite
  • PE: abnormal digital rectal exam, otherwise unremarkable

Clinical workup

  • PSA 38 ng/mL, LDH 415 U/L
  • Staging bone scan and abdominal/pelvic CT scan demonstrated localized disease
  • Core needle biopsy with TRUS showed adenocarcinoma of the prostate
  • Diagnosis: Stage T2N0M0 — intermediate risk adenocarcinoma of the prostate
  • Gleason grade group 5
  • ECOG PS 1

Treatment and Follow-Up

  • EBRT + ADT was initiated; stable disease, completed 18 months of ADT
    • 6-months follow-up at undetectable PSA

2017

  • He complained of increasing hip pain, new onset back pain and urinary frequency
  • PSA 29.4 ng/mL              
  • Bone scan showed evidence of two osteoblastic lesions in the right hip (0.8 cm and 1.1 cm)
  • Abdominal/pelvic CT showed a 2.1 cm left pelvic mass; evidence of inguinal, iliac and axillary lymph node involvement
  • He was re-staged to T2N1M1b - IVB
  • Started treatment on enzalutamide 160 mg PO qDay

2018

  • After 8 months on enzalutamide PSA 60.7 ng/mL
    • Abdominal/pelvic CT showed enlargement of left pelvic mass and progressive adenopathy
    • Bone scan revealed progression of disease
    • Patient was started on docetaxel 75 mg/m2 IV q3W + daily prednisone 5 mg POq12hr
    • After 4 cycles patients suffered from mild bilateral digital neuropathy, pitting of the nails, fatigue and stomatitis; due to toxicities docetaxel was discontinued
      • PSA 75.1 ng/mL, LDH 870 U/L
    • Cabazitaxel 20 mg/m2IV q3W + prednisone 10 mg PO qDay + pegfilgrastim was initiated