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 Nov 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. 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.
