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Abstract: The patient had radical prostate cancer surgery in our hospital in 2017, this time he came to the hospital due to worsening bone pain, and was diagnosed with metastatic desmoid-resistant prostate cancer after examination. ADT (androgen deprivation therapy) + docetaxel injection + prednisone acetate tablets + dalotamide tablets were given. After treatment, the patient’s bone pain symptoms were significantly reduced, PSA continued to decrease, and metastases were significantly shrunk.
[Basic information] Male, 77 years old
Disease Type】Metastatic destructive resistant prostate cancer
Hospital】The First Affiliated Hospital of Zhengzhou University
Date of Consultation】February 2022
Treatment plan】ADT (androgen deprivation therapy) + docetaxel injection + prednisone acetate tablets + dalotamide tablets
Treatment period】Outpatient treatment, 21 days for one cycle, 4 cycles in total, review every cycle
Treatment effect】Significant reduction of bone pain symptoms, continuous reduction of PSA, and significant reduction of metastases
I. Initial consultation
The patient underwent robotic-assisted laparoscopic radical prostate cancer surgery in October 2017 for “prostate occupancy”, and at this stage, the patient came to the hospital in February 2022 with worsening bone pain and elevated PSA (22.00ng/mL), testosterone T0.464↓ng/mL, MRI. “postoperative prostate cancer” changes, no obvious recurrent occupying signs in the pelvis, abnormal reinforcing signal in the small rotor and inter-rotor of the left femur, newer than before compared with the old film; CT showed high density shadow in the left humerus, scapula, some ribs and vertebrae after radical prostate cancer surgery, bone destruction in the right 6th rib with soft tissue mass shadow, newer than before. Newer than before. The results of the comprehensive examination were considered to be bone metastasis of prostate cancer, and the patient was admitted to the hospital.
Treatment history
The patient was treated with oral enzalutamide soft capsules after robotic-assisted laparoscopic radical prostate cancer surgery under general anesthesia in 2017, and metastatic destructive resistant prostate cancer was suspected on the current review. After communication with the family, chemotherapy with docetaxel injection + prednisone acetate tablets was given, and the patient’s bone pain symptoms were relieved more than before, and then the treatment was changed to ADT (androgen deprivation therapy) + docetaxel injection + prednisone acetate tablets + dalotamide tablets for 21 days as one treatment cycle for a total of 4 cycles, after which the patient’s bone pain symptoms were relieved more than before, PSA decreased significantly, and imaging improved.
III. Treatment effect
The patient’s PSA level decreased significantly after treatment, and after the 4th cycle of chemotherapy, tPSA 6.09ng/mL and fPSA 0.67ng/mL were retested.
MRI and bone ECT examination suggested that the metastases in the patient’s body were significantly reduced. In terms of clinical manifestations, the patient’s bone pain symptoms were significantly reduced, physical mobility and diet were significantly improved compared with before, and there were no significant side effects of chemotherapy such as bone marrow suppression and gastrointestinal symptoms.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment. In this case, the patient went through almost all stages of prostate cancer and received a combination of radical surgery, ADT treatment, ADT + new anti-androgen therapy, ADT + chemotherapy, ADT + chemotherapy + new anti-androgen therapy and other regimens. Patients need to strictly prohibit alcohol consumption, drink more water and urinate more often after discharge. Be appropriately active, but avoid heavy physical labor, strenuous activities and overexertion to prevent pathological fractures. Pay attention to rest, ensure sufficient sleep, and relax. Take medication regularly, come to the hospital for follow-up and testing of PSA and other related indexes on time, and observe the tumor condition.
V. Personal insight
Prostate cancer is the most common malignant tumor in elderly men with high incidence and most of them will eventually enter mCRPC (metastatic desmoplastic refractory prostate cancer). For prostate cancer patients in the mCRPC stage, new anti-androgenic drugs such as abiraterone acetate tablets and enzalutamide soft capsules are commonly used clinically, especially after the advent of Latitude and other related studies, the early application of new anti-androgenic drugs may lead to more common patients with mCRPC in clinical practice. The patient in this case has a significant treatment effect at this stage and has been in the mCRPC stage for more than 40 months, which is a good example of the whole comprehensive treatment and management of prostate cancer patients and is a typical case. In conclusion, we suggest that patients with prostate cancer should retain their confidence, seek timely medical care and receive standardized holistic management to obtain better survival benefits.