Prostate cancer
CRPC: treatment in daily clinical practice

Leonard (71 years old)

Leonard, 71 years old, has CRPC.

Course of the disease:

  • 5 years ago: RP + ePLND for high-risk PCa (pT3aN0M0, ISUP grade 4, undetectable postoperative PSA)
  • 1 year later: salvage EBRT + 6 months adjuvant ADT for rising PSA (0.4 ng/ml)
  • 2 years later: PSA 5.4 ng/ml, negative bone and CT scan; start ADT monotherapy
  • 14 months later: PSA 7.7 ng/ml, serum testosterone 15 ng/dl, CT scan: retroperitoneal lymph nodes up to 5 cm short-axis diameter, ALP 71 U/l. The patient, now having CRPC, was treated with docetaxel and the PSA dropped to 1.9 ng/ml. The lymph node metastases shrank by 36% (RECIST).

Now, 10 months after starting docetaxel:

    • PSA: 26.8 ng/ml
    • Radiographic progression of lymph nodes (43% increase from nadir post-docetaxel)
    • Bone scan: 4 metastases; the patient experienced mild bone pain
    • ALP: 185 U/l
    • No visceral metastases
    • ECOG PS: 1

Which treatment option would you choose for this patient?