A 74-Year-Old Man With Metastatic Castration-Resistant Prostate Cancer (mCRPC)

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EP: 1.A 74-Year-Old Man With Metastatic Castration-Resistant Prostate Cancer (mCRPC)

EP: 2.Assessing Tolerability and Clinical Considerations in Abiraterone Formulation Selection

EP: 3.Formulation Matters: Tailoring Abiraterone Dosing for Optimal Absorption and Tolerability

EP: 4.The Impact of Comorbidities, Adherence, and Access on mCRPC Treatment Decisions

mCRPC Case Presentation

This segment presents a comprehensive case study of a man aged 74 years diagnosed with mCRPC. The patient’s journey began 4 years ago with high-risk localized prostate cancer, progressing through radical prostatectomy, biochemical recurrence, salvage radiation therapy, and eventually developing bone metastases. Despite initial treatment with androgen deprivation therapy and enzalutamide, the patient experienced disease progression with rising prostate-specific antigen levels from 2.4 to 12.1 over 3 months.

The patient’s medical history includes stage 3 chronic kidney disease, hypertension, and osteoarthritis, with no prior cardiac disease or chemotherapy exposure. Physical examination revealed mild tenderness over the right iliac crest, and imaging studies showed new bone lesions in the right iliac crest and femoral head. Laboratory results confirmed castrate testosterone levels, elevated alkaline phosphatase, and negative genetic testing for BRCA1/2 and other homologous recombination repair mutations.

Treatment options for this progressing mCRPC case included switching to abiraterone acetate, initiating chemotherapy, or considering targeted radiopharmaceuticals like radium-223 or lutetium-177. Given the patient’s performance status and preference for oral therapy over cytotoxic chemotherapy, the decision was made to proceed with abiraterone. The segment emphasizes the importance of individualized treatment selection based on patient factors, prior therapies, and disease characteristics in managing advanced prostate cancer.