Patient Profile Case 4

Case 4: 84 year-old male

mCRPC

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

Patient history:

Patient received treatment for co-morbid hyperlipidemia, moderate CKD.
Imaging Results (August 2021):
- CT scan: Revealed multiple lesions in the bilateral humeri and sacroiliac joints.
- Abdominal and chest CT scans: No evidence of non-regional lymph node or visceral mets or soft tissue involvement in the abdomen.
Patient diagnosed with mCRPC and initiated on abiraterone-prednisone (October 2021).

Low BMI and ECOG indicating impaired functional status. Patient has ongoing musculoskeletal pain due to metastatic bone disease. Despite symptoms, patient has declined chemotherapy.

Disease progression and Management timeline

Diagnosis and Work-up

Patient diagnosed 5 years ago with Gleason 9, T2c N0 M0 adenocarcinoma of the prostate.
Patient underwent EBRT and ADT in April 2020, but PSA levels began to rise shortly after.

Current Presentation

Repeat imaging with PSMA-PET reveals new lesions with additional hot spots in the humerus and no changes to the lymph nodes or visceral involvement.
Patient is requiring regular acetaminophen use for pain relief.
BMI: 17
ECOG Performance Status: 2
HRR gene panel: negative

What is the next step for managing this patient?

Patient Case 4: 84 year-old male

De-novo mCRPC patient

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^{ADT=androgen deprivation therapy; BMI=body mass index; CT=computed tomography; EBRT=external beam radiation therapy; ECOG=Eastern Cooperative Oncology Group; HRR=homologous recombination repair;}
^{mCRPC=metastatic castration resistant prostate cancer; PET=positron emission tomography; PSA=prostate-specific antigen; PSMA=prostate-specific membrane antigen.}
^{*Fictitious patient. May not be representative of all cases.}
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