Opinion
Video
Case 2: A 63-Year-Old Man With Recurrent HSPC
Author(s):
Paul E. Dato, MD, discusses how a 63-year-old Black man with recurrent hormone-sensitive prostate cancer (HSPC) presented with high-grade disease and multiple metastases after initial prostatectomy, requiring accurate staging and comprehensive treatment planning.
Clinical Brief: Case Presentation of Recurrent Hormone-Sensitive Prostate Cancer
Main Discussion Topics
- Patient Profile: 63-year-old Black man with urinary retention, fatigue, and poor appetite
- Initial Presentation: PSA of 138 ng/mL, Gleason score 8 adenocarcinoma, initially negative for metastases
- Disease Progression: Post-prostatectomy PSA decline to 0.2 ng/mL, followed by rise to 90 ng/mL after 1 year
- Advanced Disease Features: Multiple metastatic bone lesions and diffuse liver lesions, negative genetic testing
Key Points for Physicians
- Gleason score 8 (Grade Group 4) considered high risk, associated with aggressive disease behavior
- PSMA PET/CT recommended over conventional imaging in high-risk patients due to superior sensitivity and specificity
- Significantly elevated initial PSA (138 ng/mL) suggests high likelihood of metastatic disease
- Treatment strategy determination requires accurate staging with consideration of tumor volume and metastatic burden
Notable Insights
The presenter emphasizes the importance of using advanced imaging techniques like PSMA PET/CT for accurate staging in high-risk cases, which can significantly impact treatment planning and prognostication.
Clinical Significance
Accurate disease characterization through appropriate imaging and biomarker assessment is essential for determining optimal treatment strategies and defining prognosis in recurrent prostate cancer.
