Hormone Sensitive Metastatic Castration-Resistant Prostate Cancer
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
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