A 55-year old gentleman presented with nocturia and PSA level of 4.5 ng/mL
PMH: Insignificant
DRE revealed an abnormal area of hardness
Biopsy showed adenocarcinoma of the prostate gland with a Gleason score 6 [3+3], clinical tumor stage T1c
The patient remained on active surveillance
November 2015
When he returned after 1 year:
PSA, 10 ng/mL
Repeat biopsy showed Gleason 7 [4+3] with 8 of 12 cores positive
CT scan was negative for metastases
He remained asymptomatic
He was started on a 3-month depot injection of goserelin
February 2016
PSA, 34 ng/mL
CT scan was negative for metastases
He was started on abiraterone and prednisone
PSA declined to 15 ng/mL and remained stable
After 4 months, he developed cardiac arrhythmia attributed to prednisone; he was switched to enzalutamide
PSA remained stable
August 2016
3 months following therapy switch, the patient complained of severe fatigue
CT scan showed enlarged lumbar spine and pelvic bone metastases
18F-FDG PET showed increased FDG uptake in several areas of the lumbar spine and pelvis
PSA, 45 ng/mL
ALP, 225 U/I
Radium-223 therapy was initiated and enzalutamide was continued