Daniel P. Petrylak, MD, presented “Advanced Prostate Cancer Challenging Case Discussion” during the 33rd International Prostate Cancer Update on January 24, 2023, in Vail, Colorado.
How to cite: Petrylak, Daniel P. “Advanced Prostate Cancer Challenging Case Discussion.” January 2023. Accessed Jul 2024. https://grandroundsinurology.com/challenging-case-discussion-panel-petrylak/
Advanced Prostate Cancer Challenging Case Discussion – Summary
Daniel P. Petrylak, MD, moderates this discussion panel on challenging prostate cancer case studies. Dr. Petrylak describes the first case whereby a patient had a prostate specific antigen (PSA) of 24 and underwent radical prostatectomy; his PSA never normalized and rose to 40. Androgen deprivation therapy (ADT) commenced and continued for five years until his PSA rose despite a castrate testosterone level. The patient’s bone scan demonstrated sacral metastases. Testing demonstrated no germline mutations and the patient received Sipuleucel T and began treatment with abiraterone/prednisone; PSA nadired at .4. A year and a half later the patient’s PSA rose to 4.8 and he was found to have stable bone metastases.
After the panel decides on a treatment plan for the first case, Dr. Petrylak moves to the second case, whereby a patient presented with celiac, para-aortic and iliac chain lymphadenopathy, early right-side hydronephrosis, a PSA of 19.4, and a biopsy of the left neck lymph node mass showed metastatic adenocarcinoma consistent with prostatic primary. Treatment included bicalutamide/leuprolide, switching to abiraterone/prednisone. In six months, PSA was undetectable. The patient progressed in terms of the soft tissue disease and required a stent for the hydronephrosis, began docetaxel with no response after five cycles, and started cabazitaxel with cycles three and four dose-reduced due to neuropathy.
About The 33rd Annual International Prostate Cancer Update:
The International Prostate Cancer Update (IPCU), founded in 1990, is a multi-day CME conference focused on prostate cancer treatment updates with expert, international faculty. It is led by expert physicians and is designed for urologists, medical oncologists, radiation oncologists, and other healthcare professionals involved in the diagnosis and treatment of prostate cancer. The 33rd iteration of the meeting occurred January 22-25, 2023 in Vail, Colorado. To view more educational presentations from IPCU 33, visit our collection page.
ABOUT THE AUTHOR
Daniel P. Petrylak, MD, leads the genitourinary cancers medical oncology team at Smilow Cancer Hospital as director of the genitourinary cancer research group, professor, and co-director of the Cancer Signaling Network program. Dr. Petrylak joined Yale from Herbert Irving Cancer Center at Columbia University Medical Center with New York-Presbyterian Hospital, where he served as Professor of Medicine (Medical Oncology) and Urology and began his appointment in September of 2012. Dr. Petrylak is a member of the American Association for Cancer Research (AACR), American Society for Clinical Oncology (ASCO), American College of Physicians (ACP), American Association for the Advancement of Science (AAAS), American Urological Association (AUA), and the Southwest Oncology Group (SWOG). After serving for more than 20 years as the advanced bladder chair for SWOG, Dr. Petrylak is now the Vice Chair of the Genitourinary Committee. He additionally has led multiple national and international studies in prostate and bladder cancer.
Dr. Petrylak’s research interests span both prostate and bladder cancer. He led an investigator-initiated trial of docetaxel and estramustine in castration resistant prostate cancer. The results of this study supported a phase 3 trial of this combination in SWOG led by Dr. Petrylak, which in turn, supported the FDA approval of docetaxel for castration resistant prostate cancer. This was one of the first two trials to demonstrate a survival benefit in this state of disease. Dr. Petrylak has also been instrumental in the development of immunotherapy and targeted therapies for refractory bladder cancer. His work with Enfortumab Vedotin has supported the accelerated and full FDA approval of this drug.
Dr. Petrylak received his undergraduate degree from Columbia College and his medical degree from Case Western University School of Medicine. He completed his internship and residency at Albert Einstein College of Medicine and his fellowship in medical oncology at Memorial Sloan-Kettering Cancer Center. He has authored more than 200 peer-reviewed articles and book chapters on prostate and bladder cancer research outcomes.
