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.}
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