How to cite: Morris DS, Garmezy B, and Phillips JG. Treatment Intensification in Metastatic Hormone-Sensitive Prostate Cancer: A Multidisciplinary Case Review. Grand Rounds in Urology. September 2026. Accessed Oct 2026. https://grandroundsinurology.com/treatment-intensification-in-metastatic-hormone-sensitive-prostate-cancer-a-multidisciplinary-case-review/
Summary
In this case review, three experts examine treatment intensification for a patient with newly diagnosed metastatic hormone-sensitive prostate cancer. David S. Morris, MD, FACS, President, Urology Associates, Urology Associates, Nashville, Tennessee, serves as moderator and case presenter, Benjamin Garmezy, MD, Associate Director, Genitourinary Cancer Research, Sarah Cannon Research Institute, Nashville, Tennessee, provides the medical oncology perspective, and John G. Phillips, MD, MPH, Radiation Oncologist, Tennessee Oncology, Nashville, Tennessee, provides the radiation oncology perspective.
The patient is a 71-year-old man with a prostate-specific antigen of 6.9 ng/mL. Magnetic resonance imaging demonstrates a PI-RADS 5 lesion and left pelvic lymph nodes. Biopsy demonstrates extensive high-grade adenocarcinoma, including Gleason 5+5=10, Grade Group 5 disease with perineural invasion. Prostate-specific membrane antigen positron emission tomography subsequently demonstrates extensive metastatic disease involving the skeleton, with lesion SUVmax values ranging from 13 to 60. Baseline assessment includes hemoglobin 11 g/dL, platelet count 315, and creatinine 0.96 mg/dL.
The patient begins androgen deprivation therapy and an androgen receptor pathway inhibitor. The tumor board considers whether further intensification with a triplet approach is appropriate. Dr. Garmezy discusses how findings on homologous recombination repair, BRCA, and phosphatase and tensin homolog could influence treatment selection.
The panel weighs docetaxel against lutetium-based therapy. Given the extensive skeletal disease and concern about bone marrow effects, Dr. Garmezy favors docetaxel in this patient. Dr. Phillips also leans toward docetaxel but considers lutetium-based therapy reasonable if chemotherapy is declined, emphasizing close response assessment and a defined alternative treatment strategy.
ABOUT THE AUTHOR
David S. Morris, MD, FACS, is President of Urology Associates, P.C., in Nashville, Tennessee, where he also serves as Co-Director of the Advanced Therapeutics Center and Clinical Research Department. His clinical interests include urologic oncology, with a particular focus on advanced prostate cancer, as well as robotic and laparoscopic surgery, endourology, stone disease, and reconstructive urology.
Benjamin Garmezy, MD, is the Associate Director of Genitourinary Research and Executive Co-Chair of the Genitourinary Cancer Research Executive Committee at SCRI Oncology Partners. He specializes in genitourinary oncology research, overseeing clinical trials for prostate, kidney, testicular, and bladder cancers while offering a variety of treatment options to patients, including immunotherapy, chemotherapy, targeted therapy, and precision oncology.
John G. Phillips, MD, MPH, is a board-certified radiation oncologist at Tennessee Oncology in Nashville, Tennessee, and one of the founders of Health Tech Startup. He previously worked as a radiation oncologist and the medical director of Radiation Oncology Pathways at the Dana-Farber Cancer Institute in Boston, Massachusetts. His clinical specialties include internal and external beam radiation therapy, brachytherapy, and systemic radiation therapy.
