A man underwent a radical retropubic prostatectomy
A 55-year-old male underwent a radical retropubic prostatectomy in 2006. Pathology 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 of 11 nodes. Immediately following surgery, his serum prostate-specific antigen level (PSA) was undetectable.
However, 8 months after surgery, his PSA rose to 0.08 ng/mL and on follow-up 3 months later his PSA was 0.30 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 normalized.
Three years later the patient presented with a PSA of 45 ng/mL and a castrate level of serum testosterone of 23 ng/dL. He also complained of lower back and pelvic pain and fatigue and had recently experienced a weight loss of about 15 pounds.
A subsequent bone scan 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 minor reductions in his tumor volume were observed. The patient was then started on abiraterone acetate tablets 1000 mg orally once daily and continues to be monitored.
What is the State of the Science in Metastatic Castration-Resistant Prostate Cancer ?