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

Opinion
Video

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.

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.

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