ESMO Preceptorship Programme

Primary Hormone -Refractory Prostate Cancer

Adlinda Alip

Prostate Cancer– Singapore – 2016

ESMO PRECEPTORSHIP PROGRAM

� 72-year old male. No comorbidities .� Presented with left loin pain, LUTS, loss of appeti te and weight.� PS ECOG 1 PSA 25, CEA 5.2CT urogram –normal kidneyCT scan 22/2/2016:

Multiple ill-defined hypodense liver lesions, circu mferential rectosigmoid colon thickening - 6.5 cm from anal verge, 6.3 cm in length- No clear fat plane between mass and Prostate gland- heterogeneously enhancing and infilt rating the

urinary bladder base and left distal ureter with Lt hydroureteronephrosis

ESMO PRECEPTORSHIP PROGRAM

Colonoscopy

Ulcerating tumour at 7 cm from anal verge extending about

8 cm proximally

Biopsy

Poorly differentiated Adenocarcioma

Focally staining for PSA and CK 20

Bone scan-no bone mets

ESMO PRECEPTORSHIP PROGRAM

� He developed intestinal obstruction, underwent sigmoid colostomy 29/3/2016

� HPE – Suggestive of Metastatic prostate Ca� CT – Thickened wall of rectum connecting to

prostate. Lung and liver metastasis.� MRI –Tumour infiltrating from prostate to rectum,

seminal vesicles involved.

Left nephrostomy inserted on 16/5 and converted int o AGS on 23/5/16.USG guided biopsy of liver lesion 19/5/16

Metastatic adenocarcinoma suggestive of prostate carcinoma primary (IHC + for PSA)

Lucrin started 29/4/16 PSA Increasing trendTestestorone-0.4 (May 16)Docetaxel started 7/6/16Chemo stopped after 2 cycles due to poor tolerance

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PSA Trend

PSA Trend

CT scan 16/8/16:� Prostate gland and bowel -no change� Liver lesion-increased in number and size � Increased number in lung nodules � New sclerotic lesion seen at L4 Imp: worsening lung & liver mets, improving nodal mets and new bone metastasis