Prostate cancer
INACTIVE ---Treatment decision-making in castration-resistant prostate cancerStephan (71 years old)
Stephan, 71 years old, was diagnosed with high-risk PCa (cT2b; ISUP grade 4 [Gleason score 4+4]; PSA 11 ng/ml). He underwent RP + ePLND (pT3aN0M0, ISUP grade 4 [Gleason score 4+4]). Postoperative PSA was undetectable.
One year later the patient had a biochemical recurrence (PSA 0.4 ng/ml) and received salvage EBRT + 6 months adjuvant ADT.
Two years later:
- PSA increased to 5.4 ng/ml
- PSA-DT: 7 months
- Bone scan and CT scan negative
The patient was treated with ADT.
14 months later:
- PSA rising to 7.7 ng/ml
- PSA-DT: 6 months
- Serum testosterone: 15 ng/dl
- CT scan showed retroperitoneal lymph nodes up to 5 cm short-axis diameter
- ALP: 71 U/l
The patient, now having CRPC, was treated with enzalutamide and the PSA dropped to 1.9 ng/ml. The lymph node metastases shrank by 36% (RECIST).
Ten months after starting enzalutamide:
- PSA increased to 26.8 ng/ml
- Radiographic progression of lymph nodes (43% increase from nadir post-enzalutamide)
- Bone scan showed 4 metastases and the patient experienced mild bone pain
- ALP: 185 U/l
- No visceral metastases
- ECOG PS: 1