Patient Profile Case 2

Case 2: 72 year-old male

mCSPC to mCRPC without lymph nodes

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

Patient History

Patient received treatment for co-morbid hypertension.
Biochemical progression detected in October 2024 with PSADT <6 months.

Patient reports a

reduced quality of sleep

and is experiencing
urinary incontinence
. Symptoms are
negatively impacting
his willingness to attend social events. Patient has recently started on mild analgesic for hip pain.

Disease progression and Management timeline

Diagnosis and Work-up

Elevated PSA identified during routine screening prompted Urologist referral.
Initial Imaging (April 2022):
- 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 + abirateroneprednisone + docetaxel
(July 2022).

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.
Patient diagnosed with mCRPC
ECOG Performance Status: 1
HRR gene panel: negative

What is the next step for managing this patient?

Progression from mCSPC to mCRPC

Without 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.}
^{© 2025, Bayer Inc.}