Patient Profile 2: A 78-Year-Old Man with Metastatic Prostate Cancer
A urology specialist reviews the case of a 78-year-old patient with metastatic prostate cancer, analyzes their risk level and prognosis, and discusses frontline treatment.
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
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 #2: A 78-Year-Old Man with Metastatic Prostate Cancer
Initial Presentation
- A 78-year-old cap screening naive man presents with right hip pain and fatigue
Clinical workup
- Abnormal DRE; PSA 140 ng/mL; Hgb 9.9 g/dL
- Biopsy revealed diffuse Grade Group 4 and 5 prostate adenocarcinoma
- Imaging with CT and 99Tc bone scan revealed multiple metastatic bone lesions in the right hip and pelvis in the pelvis, liver lesions c/w mets, and a few scattered LN
Diagnosis
- Patient is diagnosed with de novo metastatic prostate cancer (de novo M1CSPC)
- Germline and somatic genetic testing are negative
This is a synopsis of a Case-Based Peer Perspectives series featuring Paul M. Yonover, MD, FACS, of Uropartners/SolarisHealth Partners.
Dr. Paul Yonover presented a case of a 78-year-old man with no prior prostate cancer screening who presented with right hip pain and fatigue. Exam revealed a rigid, nodular prostate and PSA of 140 ng/mL. Biopsy showed diffuse Gleason grade groups 4 and 5 prostate cancer. Staging imaging demonstrated bone metastases in the right hip/pelvis, liver lesions consistent with metastases, and a few enlarged pelvic lymph nodes, establishing a diagnosis of de novo metastatic castrate-sensitive prostate cancer (mCSPC) with visceral, osseous and nodal involvement. Germline and tumor genomic testing were unrevealing.
Dr. Yonover characterized this as high risk, high volume de novo mCSPC given the presence of metastatic disease in multiple sites including the viscera categorizing it as m1c disease. It remains castrate-sensitive as the patient is androgen deprivation therapy (ADT) naïve. However, the prognosis is guarded due to the visceral metastases, and while overall survival can be prolonged with today’s therapies, this disease is not curable.
Unless contraindicated, Dr. Yonover would initiate a gonadotropin releasing hormone (GnRH) agonist or antagonist for foundational ADT, but this would be insufficient monotherapy for this high-risk presentation. The ADT forms the basis on which additional therapies can be layered, such as chemotherapy and/or next-generation antiandrogens, to provide further disease control. He would also consider stereotactic body radiotherapy to symptomatic bone metastases for local control and palliation.
*Video synopsis is AI-generated and reviewed by Urology Times editorial staff.
Enzalutamide granted approval in EU for nmHSPC
April 24th 2024The approval is supported by data from the phase 3 EMBARK trial, which demonstrated that enzalutamide with or without leuprolide prolonged metastasis-free survival compared with leuprolide alone in patients with high-risk biochemically recurrent nmHSPC.
