William Oh, MD: Ideal Treatment Options and Favorable Approaches

What treatment options would you consider for this patient and what approaches would you favor?

The treatment options for an elderly man with metastatic CRPC are really extensive. Over the last several years we’ve had the advantage of multiple new approved treatments for metastatic CRPC. These include immunotherapeutic approaches, AR-targeted therapies, cytotoxic chemotherapy, and also bone-targeted therapy. We’re really in a good situation in terms of the options that are available for a patient like this. In my practice I would typically start with what I think are the most efficacious and probably the best-tolerated treatments, particularly given his age.

CASE: Metastatic Prostate Cancer (Part 1)

Stanley S is an 83-year-old Caucasian male whose past medical history includes diagnosis of adenocarcinoma of the prostate in 2012 with no evidence of metastasis. At the time, he was started on bicalutamide and his serum PSA levels subsequently decreased to 1.2 ng/ml.

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

• His serum PSA level is 56.9 ng/ml and his alkaline phosphatase is 258 U/L
• CT scan shows enlarged lumbar bone metastasis with associated soft tissue component, as well as symptomatic nodes with lumbar bone metastases
• Biopsies of the prostate and transrectal ultrasound reveal the prostate is 42 grams
• Ten of 14 cores are positive for prostate cancer for a Gleason score of 8 (4 + 4)
• His ECOG performance status score is a 2