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