Metastatic Castrate Resistant Prostate Cancer

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Metastatic Castrate Resistant Prostate Cancer
Metastatic Castrate Resistant Prostate Cancer
Case

During routine screening, a 65-year-old man was found to have a PSA level of 4ng/mL, increased from 0.4ng/mL the year prior. Biopsy demonstrated a Gleason 4+4 adenocarcinoma of the prostate. He underwent a radical prostatectomy, with the identification of a Gleason 4+4 (with a tertiary component of 5) adenocarcinoma, involving 65% of the prostate gland with extraprostatic extension, extensive perineural invasion, and seminal vesicle involvement, but with negative margins; 0/12 lymph nodes were positive for prostate cancer (pT3b, pN0).

The patient's postoperative PSA level reached a nadir of 0.2ng/mL, which subsequently increased to 2.4ng/mL within 6 months of the surgery. He was started on androgen deprivation therapy (ADT) with an LHRH agonist and an antiandrogen. His PSA level has now risen to 7.9ng/mL.

His testosterone level is 27ng/dL after 8 months of combined androgen blockade therapy. Bone scan demonstrates new bone lesions. The patient also has an ECOG PS 1, and the pain is currently being controlled with acetaminophen.


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