Patient Profile Case 1

Case 1: 79 year-old male

mCSPC > mCRPC with lymph nodes

_{^{*Fictional patient and fictional personal information.}}

Patient history:

Patient received treatment for co-morbid diabetes and hypertension.
Biochemical progression detected within 18 months with PSADT <6 months.
Patient diagnosed with mCRPC and initiated on enzalutamide (January 2022).

Patient reports a reduced quality of sleep and is experiencing urinary incontinence. Symptoms are negatively impacting his willingness to attend social events. Pain management has been increasingly challenging, with an increase in analgesic use due to pain associated with hip metastases.

Disease progression and Management timeline

Diagnosis and Work-up

Elevated PSA identified during routine screening prompted Urologist referral.
Initial Imaging (February 2020):
- CT scan: Revealed multiple lesions in the lumbar vertebrae (L2 and L4) and hip.
- Abdominal and chest CT scans: Indicated no evidence of visceral mets or soft tissue involvement.
- Pelvic scan: Several enlarged pelvic lymph nodes were noted (1-2 cm in short axis).
Patient diagnosed with de novo mCSPC and initiated on ADT (April 2020).

Current Presentation

Follow-up imaging reveals radiographic progression with new lesions with hot spots in the pelvis, with no changes in visceral involvement or pelvic lymph nodes.
ECOG Performance Status: 1
HRR gene panel: negative

What is the next step for managing this patient?

Progression from mCSPC to mCRPC

With lymph nodes

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^{ADT=androgen deprivation therapy; CT=computed tomography; ECOG=Eastern Cooperative Oncology Group; HRR=homologous recombination repair; mCRPC=metastatic castration resistant prostate cancer;}
^{mCSPC=metastatic castration sensitive prostate cancer; PSA=prostate-specific antigen; PSADT=prostate-specific antigen doubling time.}
^{*Fictitious patient. May not be representative of all cases.}
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