A 55-year-old male underwent a radical retropubic prostatectomy
A 55-year-old male underwent a radical retropubic prostatectomy in 2006. Pathologic analysis conducted at that time revealed adenocarcinoma of the prostate gland with a Gleason score of 4 + 4, positive surgical margins, and lymph involvement in 4 pelvic nodes. Immediately following surgery, his serum prostate-specific antigen (PSA) level was undetectable.
However, 8 months after surgery, his PSA rose to 0.8 ng/mL and on follow-up 3 months later his PSA was 3 ng/mL. The patient was treated with androgen deprivation therapy (ADT) using the gonadotropin-releasing hormone (GnRH) agonist leuprolide acetate (depot formulation at a dose of 7 mg once a month), and his PSA level became undetectable.
Three years later the patient presented with a PSA of 65 ng/mL and a castrate level of serum testosterone of 23 ng/dL. His PSA-doubling time (PSA-DT) was < 6 months. The patient also complained of lower back and pelvic pain and severe fatigue and had recently experienced a weight loss of about 15 pounds.
Subsequent computed tomography (CT) and bone scans showed clear evidence of metastatic disease and he was treated with docetaxel 75 mg/m2 every 3 weeks plus prednisone (5 mg twice daily) for 8 cycles. Although he initially experienced some symptomatic relief, only very minor reductions in his tumor volume were observed. The patient was considered unresponsive to docetaxel and subsequent treatment options were discussed.
Discuss Newer Treatment Options for Metastatic Castration-Resistant Prostate Cancer