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Track 1
Case 1
presented to:
Dr Anthony V D’Amico,
Dr Laurence Klotz and
Dr Daniel P Petrylak |
Case from the practice of Atif M Hussein, MD:
A 71-year-old man treated in 1999 with external-beam radiation
therapy (EBRT) for Gleason 7 adenocarcinoma of the prostate.
Post-EBRT PSA nadir was 0.2, but it rose to 6.7 by 2001, at which
point leuprolide was initiated, resulting in a PSA decline to 3.1.
In 2003 his PSA level began rising and, despite the addition
of bicalutamide, increased to 80 with bone scan evidence of
multiple metastases. He received a second round of EBRT, six
cycles of docetaxel with prednisone and zoledronic acid with
continuation of leuprolide.
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Track 2
Case 2
presented to:
Dr D’Amico,
Dr Klotz and
Dr Petrylak |
Case from the practice of Srinath Sundararaman, MD:
A 54-year-old man diagnosed with synchronous rectal (T3N1M0)
and prostate (T2aNxM0, Gleason 7) carcinomas in 2002. He was
treated with neoadjuvant capecitabine, leuprolide and pelvic
radiation therapy and underwent an APR with subsequent
reanastomosis. After surgery, he received a seed implant boost to
the prostate bed, adjuvant capecitabine and was maintained on
leuprolide for two years. He returned for follow-up in 2005 with a
PSA level of 9 associated with a nine- to 10-month doubling time.
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Track 3
Case 3
presented to:
Dr D’Amico,
Dr Klotz and
Dr Petrylak |
Case from the practice of Benjamin M Tripp, MD:
An 82-year-old man who presented five years earlier with a PSA
level of 158, a 265-g prostate and 18 benign biopsies. Finasteride
was initiated. A bone scan performed soon thereafter was
diffusely positive, but 16 additional biopsies and TURP tissue were
negative for adenocarcinoma. Rib biopsy showed metastatic,
poorly differentiated prostate cancer. He received combined
androgen blockade (bicalutamide and leuprolide) with zoledronic
acid. His PSA nadired at 0.1, but six months later it rose to 15.4.
After a short biochemical response to bicalutamide withdrawal,
his PSA level resumed its climb, indicating androgen-independent
prostate cancer. |
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Track 4
Case 4
presented to:
Dr D’Amico,
Dr Klotz and
Dr Petrylak |
Case from the practice of Martin K Dineen, MD:
A 66-year-old man with a PSA level of 7 was diagnosed with
Gleason 6 prostate cancer and treated with EBRT in 1996.
He enrolled in a clinical trial, received high-dose adjuvant
bicalutamide for two years and did well until the sixth year
postdiagnosis, when his PSA level rose from undetectable to 2.2
within a 12-month period. After a positive TRUS biopsy of the
prostate bed, whole-gland salvage cryoablation was performed.
18 months later, his PSA level began to rise and he received an
LHRH agonist, to which he has experienced a durable response
with a continuous undetectable PSA level. |
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Track 5
Case 5
presented to:
Dr D’Amico,
Dr Klotz and
Dr Petrylak |
Case from the practice of Michael A Simon, MD:
A 61-year-old man who underwent a nerve-sparing radical
prostatectomy revealing pT2 Gleason 6 prostate cancer with
negative nodes and margins. He presented three months
postoperatively with a PSA of 0.7, rising to 0.9 four weeks later.
Systemic disease workup was negative, with the exception
of an incidental 3-cm kidney mass suspicious for renal cell
carcinoma. Salvage EBRT was initiated to address any residual
local disease, resulting in a PSA decline to 0.6. |
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Track 6
Case 6
presented to:
Dr Judd W Moul and
Dr William K Oh |
Case from the practice of Alan M Nieder, MD:
An 81-year-old man, status-post radical prostatectomy 20
years prior, presented with a PSA of 12 and a nine-month
doubling time. Physical examination, CT scan and bone scan
results showed no clinical evidence of metastatic disease. The
patient was started on LHRH agonist monotherapy and had an
undetectable PSA within three months of the first injection. |
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Track 7
Case 7
presented to:
Dr Moul and Dr Oh |
Case from the practice of James A Reeves, MD:
A 48-year-old man presented with a PSA level of 9 and a
normal digital rectal exam. Prostate biopsy showed nine of
12 positive cores with bilateral evidence of Gleason 6 and 7
adenocarcinoma with no evidence of perineural invasion. Bone
and CT scans were negative for metastatic disease, and he
elected to undergo radical prostatectomy. |
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Track 8
Case 8
presented to:
Dr Moul and Dr Oh |
Case from the practice of Joseph F Pizzolato, MD:
A 74-year-old man with a history of radical prostatectomy and
continuous postoperative antiandrogen therapy since 1994
recently presented with a rising PSA (nine-month doubling time)
and diffuse skeletal metastases. He received radiation therapy
for impending spinal cord compression and then began a trial
of ketoconazole. His PSA level of 75 quickly rose to 120 in the
presence of increasing hip pain. He enrolled on the CALGB-9401
clinical trial and initiated docetaxel with a randomization to
bevacizumab versus placebo. His PSA level dropped to 17, and
interim scans show evidence of disease improvement. |
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Track 9
Case 9
presented to:
Dr Moul and Dr Oh |
Case from the practice of Raul Ravelo, MD:
A 51-year-old asymptomatic man presented with a PSA level
of 57.6. Biopsy revealed high-volume, Gleason 7 prostatic
adenocarcinoma with perineural invasion. Bone and CT scans
showed no evidence of metastatic disease. He underwent
radical prostatectomy, which revealed approximately 90
percent infiltration with tumor, positive surgical margins and
extraprostatic adipose tissue invasion. |
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Track 10
Case 10
presented to:
Dr Moul and Dr Oh |
Case from the practice of Dr Hussein: A 61-year-old man with a history of symptomatic, surgically
managed Crohn’s disease presented with a rise in PSA level
from 2.3 to 6.1 over a one-year span. Prostate biopsy revealed
Gleason scores of 8 and 9 in five of 12 cores. While seeking
multiple treatment opinions, he received four doses of monthly
leuprolide. He ultimately underwent a radical prostatectomy,
which revealed seminal vesicle involvement, 12 negative
lymph nodes and negative surgical margins. His two-month
postoperative PSA level was undetectable. |
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