Hormone Sensitive Metastatic Castration-Resistant Prostate Cancer

Hormone Sensitive mPC progressing to mCRPC

March 2015

H&P:

• A 76-year old gentleman presented to his urologist with nocturia and lower back pain
• PMH: unremarkable
• Digital rectal examination revealed an abnormal area of hardness

Imaging:

• Transrectal ultrasound and biopsy revealed adenocarcinoma of the prostate gland with a Gleason score 8 [4+4] with 9 of 12 cores positive
  • PSA, 85.3 ng/mL
  • Testosterone, 300 ng/dL
• CT scan showed multiple metastases of the spine
• He was started on abiraterone + prednisone + goserelin
• PSA and testosterone level continued to decline over the next 2 years to PSA, 0.1 ng/ml; testosterone <3 ng/dL.

March 2018

• After 3 years of therapy patient reported increasing fatigue
• PSA and testosterone levels began to rise
  • PSA increased from 0.5 ng/ml to 1.0 ng/ml; 2.0 ng/mg to 4.8 ng/ml at 2-3 month intervals
  • Testosterone, <3 ng/dL
  • CT scan shows several new bone metastasis; others improved
• Patient is diagnosed as castration resistant and abiraterone + prednisone was discontinued
• Radium-223 therapy was initiated