A CASE OF CASTRATION-RESISTANT PROSTATE CANCER THAT COMPLETELY AMELIORATED AFTER TRANSITION TO BEST SUPPORTIVE CARE

Abstract

The patient was a 78-year-old man who, at 67 years of age, had been diagnosed with prostate cancer cT3bN1M0 (Gleason score 5+5) and started on androgen ablation therapy. Thereafter, the cancer had developed into castration-resistant prostate cancer; thus, after surgical castration, the patient was treated with 27 courses of docetaxel, as well as enzalutamide and abiraterone. However, new metastases appeared in the paraaortic lymph nodes, post which, the patient was treated with 25 courses of cabazitaxel. However, the paraaortic and intrapelvic lymph nodes became enlarged, the patient developed rectal occlusion and urinary retention due to growth of the primary tumor, and his general condition deteriorated. Hence, the patient decided to abandon treatment approximately 10 years after initial diagnosis, underwent cystostomy, and transitioned to best supportive care. After stopping treatment, his general condition started to improve, and approximately 6 months later, his PSA levels had fallen from 55.5 ng/mL to 19.3 ng/mL and the lymph nodes had also reduced in size. When the cancer was treated with local radiation, the enlarged tumor disappeared, and the patient was able to urinate again. It has now been 2.5 years since treatment was stopped, and both, the paraaortic and intrapelvic lymph nodes have reduced in size to < 1 cm, and the PSA value continues to remain less than 0.008 ng/ml.