High-Risk Prostate Cancer: Treatments Following Radical Prostatectomy

EP: 1.Patient Profile 1: A 66-Year-Old-Man with Prostate Cancer

EP: 2.Imaging and Biomarker Testing Considerations in Prostate Cancer

EP: 3.Treatment Options for Patients With Prostate Cancer

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EP: 4.High-Risk Prostate Cancer: Treatments Following Radical Prostatectomy

EP: 5.Patient Profile 2: A 78-Year-Old Man with Metastatic Prostate Cancer

EP: 6.Treatment Considerations for Patients With High-Risk, High-Burden Prostate Cancer

EP: 7.Unmet Needs Surrounding the Treatment of Prostate Cancer

Case #1: A 66-Year-Old-Man with Prostate Cancer

Initial Presentation (June 2022)

• A 66-year-old man reported mild urinary frequency to his primary care physician

Clinical workup

• After an elevated serum PSA 22 ng/mL is noted, patient presents to his urologist
• Family history of breast cancer (patient’s mother diagnosed at age 82)
• Digital rectal exam (DRE) unremarkable, overall physical exam unremarkable
• MRI revealed a 40 gm prostate; no extra-prostatic extension, no nodal involvement; 1 ROI, PIRADS-5
• Transperineal (TP) MRI fusion biopsy demonstrated prostate adenocarcinoma andGleason score 8/Grade Group 4 in 9 of 12 tissue samples and Gleason score 9/Grade Group 5 in the region of interest
• Germline genetic testing revealed no actionable mutations; CT and bone scan revealed no extra-prostatic involvement.

Initial Treatment (starting July 2022)

• Patient underwent robotic assisted lap radical prostatectomy (RALP) + PLND; no surgical complications
• Pathology confirmed GG5 prostate disease with pT3bN1R1 designation
  • Positive surgical margins; 1 of 12 obturator lymph nodes were positive

12-week Follow-up Notes (October 2022)

• Post-surgical PSA is undetectable at 12 weeks
• Minimal GSI (<1 pad/day)