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Expert Opinion / Cases · July 28, 2021

75 Year Old Man With Non-Metastatic Castration Resistant Prostate Cancer

Written by
Pedro C. Barata MD

 

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  • Paul Pomerantz

    Jul 28, 2021

     Continue current therapy 

  • Saad Benjelloun

    Jul 29, 2021

    Refer patient to radiation for SBRT for T12 and L3

  • Charles Maack

    Jul 29, 2021

    order a thoracic and lumbar MRI spine and refer to Radiation Oncology if lesions detected in MRI scan

  • Sandeep Kumar  Sharma

    Jul 30, 2021

    refer patient to Radiation Oncology for SBRT of T12 and L3

  • sophie ivy

    Jul 30, 2021

    #2

  • Nasrin Ghaderian

    Jul 30, 2021

    discontinue darolutamide and discuss other systemic therapy such as abiraterone acetate or high dose testosterone 

  • Edward Hettiaratchi

    Jul 30, 2021

    #2

  • olatokunbo Awodele

    Jul 30, 2021

    #2

  • Jeffrey Carrel

    Jul 30, 2021

    #2

  • Craig Carter

    Jul 30, 2021

    #2

  • Luiz Pereira

    Jul 30, 2021

    #2

  • Gib Abbitt

    Jul 30, 2021

    Happy to see high dose testosterone included as a potential treatment. Something new to consider.

  • Oliver Sartor

    Jul 30, 2021

    #1.....no need for MRI. SBRT those lesions and see what happens

  • Luis Alberto Glaría

    Jul 30, 2021

    refer patient to Radiation Oncology for SBRT of T12 and L3

  • José Luis Delgado

    Jul 30, 2021

    # 2

  • Charles Maack

    Jul 30, 2021

    My reasoning for #2 is "why subject patient to radiation before determining extent of lesions and if only then  considered to be development of metastatic PCa consider appropriate form of radiation. Until determined, ADT meds continue since they have been effective at least in PSA control. 

  • Paul Schellhammer

    Jul 30, 2021

    #1–Continued expression after one year of Daralutamide points to continued viability, therefore treat oligo mets/recognize a data free zone

  • Liefu Ye

    Jul 30, 2021

    order a thoracic and lumbar MRI spine and refer to Radiation Oncology if lesions detected in MRI scan

  • Juan Premoli

    Jul 30, 2021

    # 2

  • Paul Pomerantz

    Jul 30, 2021

    I think it’s interesting that everybody seems to want to pursue further evaluation of the two lesions as well as therapy. Since in his initial staging we do not have a targeted pet scan these lesions may have been present prior. Currently by most standards he is still castrate sensitive with a good response as he’s had no rising PSA so ideally if we had studies proving the value of targeted therapy at various metastatic sites I would agree with more aggressive approach. I don’t think at the present time we have data that supports that without evidence that these lesions were not present prior.

  • Len Scotland

    Jul 31, 2021

    Hi PSa level is undetectable and patient is asymptotic I will continue current management choice 3

  • Mark Lagos

    Aug 01, 2021

    #1

  • Richard Mandell

    Aug 01, 2021

    Continue present therapy. It seems to be working just fine. 

  • Bahram Mofid

    Aug 01, 2021

    i agree with second option

  • Ruth Avila

    Aug 04, 2021

    #1 

  • MICHAEL ZERNECK

    Aug 20, 2021

    No change!  Patient is 75 and doing well.

  • Comment deleted by Moderator.
  • Charles Maack

    Aug 30, 2021

    Question remaining: What has since transpired with this patient?

  • pedro barata

    Feb 09, 2022

    Great comments and insights so far. So this patient ended up getting an MRI of spine that did not reveal the lesions by PSMA. The patient continues on ADT plus darolutamide with undetectable PSA and great tolerance

  • Arley Soares

    Feb 17, 2022

    #1

  • Charles Maack

    Feb 17, 2022

    Thus, as provided by Pedro Barata, #2 was administered, patient can now experience some relief not having to wonder about those lesions, did not have to experience effects/side effects of radiation treatment, and continued ADT still successful. 

  • Prasanta Kumar Pradhan

    Apr 02, 2022

    MRI for further characterising the vertebral lesions seen on PSMA PET/CT 

  • Paul Pomerantz

    Apr 04, 2022

    Might consider Lutetium at this point for oligomets seen on PSMA pet scan

  • Jul 04, 2022

    Pending Moderator approval.
    Delete

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