A 69-Year-Old Man With Metastatic Hormone Sensitive Prostate Cancer

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EP: 1.A 69-Year-Old Man With Metastatic Hormone Sensitive Prostate Cancer

EP: 2.Abiraterone Acetate: Generic and Branded Options

EP: 3.Formulations, Food, and Frequency: Optimizing Absorption and Tolerability in Daily Practice

EP: 4.BRCA Mutations in mHSPC: Impact on Therapy Selection

EP: 5.Comorbidities and Adherence: Tailoring mHSPC Treatment

EP: 6.Case 2: A 63-Year-Old Man With Recurrent HSPC

Clinical Brief: Initial Presentation and Management of Metastatic Hormone-Sensitive Prostate Cancer

Main Discussion Topics

• Patient Profile: A 69-year-old Black man presenting with fatigue, nocturnal diuresis, persistent low back pain, unintentional weight loss, and urinary difficulties
• Clinical Assessment: Prostate-specific antigen (PSA) significantly elevated at 78 ng/mL, normal testosterone, mildly elevated alkaline phosphatase, mpMRI revealing PI-RADS 5 lesion with suspected extracapsular extension
• Diagnostic Findings: PET/CT showing multiple osseous metastases in lumbar spine and pelvis, pelvic lymphadenopathy, and positive germline testing for BRCA mutation
• Initial Treatment Approach: Androgen deprivation therapy (ADT) with LHRH agonist or antagonist, followed by addition of abiraterone acetate with prednisone

Key Points for Physicians

• Initial ADT reduced PSA from 78 to 17 ng/mL and improved pain score from 6/10 to 3/10
• Abiraterone acetate (1000 mg daily with 5 mg prednisone twice a day) further suppressed PSA to 9 ng/mL
• Patient maintained on abiraterone for 14 months with no mineralocorticoid effects
• Patient presentation reflects increasingly common clinical scenario due to reduced screening

Notable Insights

The presenter emphasized that this case represents a typical presentation for metastatic hormone-sensitive prostate cancer, with disease characteristics that directly influence treatment approach selection.

Clinical Significance

Disease presentation, biological and molecular markers, disease volume, timing, and location of metastatic disease all inform the optimal individualized treatment strategy for patients with metastatic hormone-sensitive prostate cancer.