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.

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