Prostate cancerADT resource management: finding the right ADT for the right patient
Archie (68 years old)
Archie, 68 years old, is a retired architect who now builds dollhouses for his granddaughters. He presents to his local emergency department with new onset bilateral lower limb weakness over the last 24 hours.
- Medical history:
- T3b N0 M0, ISUP grade 4 (Gleason 4+4) PCa; treated with radical EBRT + 2 years of ADT (LHRH agonist) 5 years ago. Off treatment and lost to follow-up
- Hypertension controlled with amlodipine
- Chronic kidney disease managed with ramipril
- Normal cranial and upper limb examination
- Leg power 2/5 bilaterally, with reduced reflexes and reduced anal sphincter tone
- MRI whole spine: T2 weighted images show osteoblastic metastatic deposits in almost all vertebrae and cord compressing lesions at T3 and T5, T6
- Blood tests: normal except ALP 850 IU/l and PSA 1,300 ng/ml
- Serum testosterone: 520 ng/dl (18 nmol/l)
Neurosurgical opinion is sought, but no operative strategy is thought possible given the disease extent and comorbidities. Dexamethasone is started and the patient receives RT to the compressive spinal cord lesions. He will start ADT + docetaxel.