Introduction: A 60-Year-Old-Man with Prostate Cancer
Gordon A. Brown, DO, presents the profile of a 60-year-old man with prostate cancer.
EP: 1.Introduction: A 60-Year-Old-Man with Prostate Cancer
EP: 2.An Expert Commentary on the Patient Profile and Considerations for Treatment and Management of Prostate Cancer
EP: 3.Available Single-Agent and Combination Therapies for mCSPC
EP: 4.Efficacy Data on Combination ADT/Apalutamide from the TITAN Trial and Real-World Analyses
EP: 5.Safety of Combination ADT/Apalutamide and Management of Adverse Events
EP: 6.A Comparison of AR Inhibitor Safety and Efficacy and Factors That Impact mCSPC Treatment Selection
EP: 7.Unmet Needs and Future Directions for Patients with Metastatic CSPC
Patient Profile: A 60-Year-Old-Man with Prostate Cancer
Initial Presentation (Jan 2019)
A 60-year-old man presented with urinary retention, fatigue, and decreased appetite
No family history of prostate cancer
Clinical workup
PSA 15 ng/mL; Hb 9.7 g/dL; ANC 1.9
DRE suggested mild abnormality/firmness with potential prostate cancer
Transrectal ultrasound (TRUS)-guided biopsy of the prostate confirmed Grade Group 2/stage c2b adenocarcinoma of the prostate, with 10 of 12 positive cores
MRI was negative for LN involvement
ECOG PS = 1
Initial Treatment (Feb-April 2019)
Patient underwent radical prostatectomy with pelvic lymph node dissection; specimen analysis revealed margin-negative, stage pT3b, node-negative, Grade Group 2/stage IIB adenocarcinoma of the prostate
Patient achieved nadir PSA within 3 months of surgery, but PSA subsequently rose to 0.5 ng/mL
Patient then underwent salvage EBRT (2.7 Gy x 26 fractions)
Post-EBRT PSA level was undetectable
6- and 7-month Post-Treatment Followup Notes (October-November 2019)
Patient’s PSA levels increased to 27.3 ng/mL in 10/2019 and 61.7 ng/mL in 11/2019.
MRI revealed two visceral metastases, one in the left lobe of the liver and one in the left superior lobe of the lung.
Given the recent findings, the patient and clinician discussed next steps for treatment. The patient noted that he still has a full-time job and enjoys being active with his family. He expressed concern about potential side effects of systemic therapy interfering with these aspects of his life.
They ultimately decided to initiate combination therapy with leuprolide and apalutamide.
Phase 1B trial to evaluate relugolix and enzalutamide in high-risk prostate cancer
July 24th 2024"Going forward after this study, we hope to be able to expand and potentially look at patients undergoing either surgery or radiation therapy, and really try to determine the potential benefit," says Kelly L. Stratton, MD, FACS.
