ABSTRACT
To investigate the clinical characteristics of metastatic hormone sensitive prostate cancer and explore the strategy of combination of new endocrine drugs.In April 2019, an 69-year-old man was admitted to the First People’s hospital of Changzhou with "gross hematuria" . Physical examination showed prostatic hyperplasia with an unsmooth hard surface. CT showed a mass in bladder and possible metastasis in right lung. Diagnostic TUR-Bt pathology showed prostatic acinar adenocarcinoma, and PET-CT showed malignant lesion of prostate with bladder invasion, multiple pelvic lymph node metastasis and lung metastasis. The diagnosis of mHSPC with lymphatic and lung metastasis was considered. The patient was treated with bicalutamide and then switched to goserelin plus acetate abiraterone with prednisone. Total prostate specific antigen (tPSA) decreased to 0.705 ng/ml after 1 month of ADT+ AAP treatment, and decreased to 0.007 ng/ml after 4 months, and then maintained at 0.003 ng/ml until January 2021. Serum testosterone decreased to 0ng/dl and maintained the whole follow-up period. After 3 months of treatment, the pulmonary metastasis was not obvious. Till the last follow-up at January 2021, the patient reported good quality of life with no serious adverse events. The efficacy of ADT combined with acetate abiraterone in the treatment of mHSPC with lung cancer was significant.
ABSTRACT
To investigate the comprehensive clinical effect of early application of novel endocrine therapy combined with docetaxel for high-risk hormone-sensitive prostate cancer. A 62 year old patient was admitted due in April 2020, presented with numbness and weakness in both lower limbs for 10 days. Multiple bone metastases including thoracic vertebra and sternum was found by thoracic magnetic resonance imaging. Total resection of T5 vertebral tumor, spinal canal decompression were performed. Bone metastases was confirmed by postoperative pathological examination, and the tumor that meets clinical diagnostic criteria for prostate acinar adenocarcinoma. The post-operative PSA was 960.602 ng/ml. Based on history, imaging, pathological and serological findings, the diagnosis of high-risk metastatic hormone-sensitive prostate cancer (mHSPC), with high tumor burden was considered. The clinical stage was T 4N 1M 1. After treatment with novel endocrine therapy (enzalutamide+ androgen deprivation therapy, 3 months) combined with docetaxel(75mg/m 2, once every 3 weeks, plus prednisone 5mg, twice daily, for 4 circles), the patient’s symptoms had improved and the lesion was found to be smaller. Novel endocrine therapy combined with docetaxel can effectively suppress disease progression. The most common adverse effects include hot flushes, fatigue, headache, and hematologic toxicity (anemia, thrombocytopenia, and neutropenia) were not observed in this case. This case exemplifies novel endocrine therapy combined with DTX therapy may be one of the effective treatment options for high-risk metastatic hormone sensitive prostate cancer.