William Oh, MD: Bone-Targeted Therapy

Would you consider bone-targeted therapy for this patient, and why?

This patient presented with metastatic prostate cancer to the bone. Traditionally we would add bone-targeted treatments in this type of setting. By bone-targeted treatments I mean bisphosphonates or RANK ligand inhibitor, drugs such as zoledronic acid, or denosumab. In hormone-sensitive prostate cancer patients, the evidence of benefit has never really been clearer, and, in fact, two large studies have not suggested that there’s a significant benefit to starting these treatments in the hormone-sensitive state. However, I do evaluate these patients in various ways.

CASE: Metastatic Prostate Cancer (Part 2)

Mathew J is a 61 year old African American male who presented to his primary care physician with lower urinary tract symptoms, including sporadic hematuria. He complains of abdominal pain and low back pain starting four months ago and increasing in frequency. Prior medical history includes non-insulin dependent diabetes mellitus, well-controlled on metformin since 2006. The patient was referred to urology for further evaluation. ng/ml.

During his most recent follow-up exam, the patient complained of intermittent back pain and increasing fatigue.

• Digital rectum exam revealed nodular prostate /L
• Serum PSA level; 129 ng/ml
• Alkaline phosphatase, 258
• TRUS/prostate biopsy: 53 gram prostate, 12/12 cores (+), Gleason 4 + 5
• CT indicates blastic lesions to lumbar spine and pelvis
• Bone Scan positive for T/L spine, pelvis, right femur, scapula
• ECOG performance status, 1