Locally Advanced Castration Resistant Prostate Cancer Undetectable 114 Months after Short Course Palliative Radiotherapy: A Case Report - Abstract
Introduction: In the last few years many new effective drug therapies have become available for the treatment of patients affected by castration-resistant prostate cancer such as new chemotherapies or second lines hormone therapies to addict to androgen deprivation therapy (ADT), while radiotherapy in this scenario is considered a palliative treatment only. We report an emblematic case.
Case Presentation: In June 2013, a 69 years old patient affected by castration resistant prostate cancer was referred to our department because of obstructive urinary symptoms. Serum prostate-specific antigen (PSA), was 33.32ng/ml, with a PSA doubling time (PSA-DT), of 1 month despite serum testosterone castration levels.
A radiolabelled [11C], choline positron emission tomography detected pelvic large disease only, with mesorectal and presacral lymph nodal metastases.
In July 2013, the patient underwent a palliative short course pelvic external beam radiotherapy (EBRT), 30Gy, 3Gy per fraction (5 fractions/week).
One hundred and fourteen months after EBRT, the patient was alive, disease free, and with no obstructive urinary symptoms.
Discussion: The patients with non-metastatic castration resistant prostate cancer (NM-CRPC), with a short PSA-DT of ?10 months are considered at high risk for the development of distant metastasis and should be treated with a second line hormonal therapy, with the addition of a modern antiandrogen to ADT until disease progression.
Long term androgen deprivation therapy causes many adverse effects and it impairs the quality of life.
According to our reported experience, EBRT could be a short-term, well-tolerated, low cost, effective treatment that should be taken into account in NM-CRPC