Detaillierte Beitrags-Information

Zurück zur Liste

Beitragstitel Rapid progression in a patient with an adenocarcinoma of the prostate despite combined first-line treatment with ADT and Abiraterone/Prednisone – a case report
Beitragscode P096
Autor:innen
  1. Manolis Pratsinis Kantonsspital St. Gallen Präsentierende:r
  2. Christian Hobi Urologie Appenzellerland
  3. Hans-Peter Schmid KSSG Kantonsspital St. Gallen
  4. Aurelius Omlin Kantonsspital St. Gallen
Präsentationsform unmoderierte Poster
Themengebiete
  • Prostata
Abstract-Text A 66-year old patient was referred for urological work-up due to a PSA elevation of 13.1 ug/l and lower back pain. DRE was suspicious for a locally advanced prostate cancer (T3), and on ultrasound bilateral hydronephrosis was diagnosed. A transrectal biopsy of the prostate and retrograde ureteropyelography with bilateral ureteral stent-implantation was performed. Histologically adenocarcinoma of the prostate with a Gleason-Score 8 (4+4) was diagnosed. Staging was completed with an abdominopelvic CT and bone-scintigraphy. A local infiltration of the seminal vesicles was seen, as well as lymph node metastases and bone metastases in C7, L2 and L4 – corresponding to a cT3b, cN1, cM1, Gleason-Score 4+4=8 (ISUP Grade 4) adenocarninoma of the prostate. Androgen deprivation therapy (ADT) with flare-up coverage (bicalutamide for four weeks) was initiated immediately. Additional treatment intensification with abiraterone/prednisone was started six weeks after initiating ADT as the patient met the “high-volume” (CHAARTED) / ”high-risk” (LATITUDE) criteria.
The patient tolerated the combination therapy well and the PSA value dropped to 1.4 ug/l after 10 weeks. However, the pain in the lower back increased and new pain in left arm appeared. A MRI long spine was performed 13 weeks after initiating ADT, demonstrating massive progression of the bone metastasis with osteolytic destruction of C7 and a pathological fracture of the L4. Because of the progressing bone lesions in the context of a falling PSA a biopsy of L4 was performed and the result showed clear cell acinary adenocarcinoma of the prostate. Staining for prostate-specific antigenand androgen receptor was negative indicating the development of an aggressive variant. Abiraterone was discontinued and a palliative radiotherapy of C7 and L4 was performed with 10x3.5=35 Gy each. Imaging was repeated after completion of radiotherapy (17 weeks after initiation of ADT) and surprisingly showed innumerable new hepatic and pulmonary metastases at a PSA value of 2.16 ug/l. Palliative chemotherapy with carboplatin/paclitaxel was initiated. Two months after initiation of chemotherapy a partial remission was seen on re-staging CT of the abdomen and chest.

Conclusion:
• Clinical deterioration should trigger radiological evaluation even in the context of a falling PSA.
• A biopsy of a progressing metastatic lesion in men with progressing prostate cancer in the context of a stable or falling PSA should be considered.