HI , I have summarised my case history as follows:-
Chief Complaints and History of Present Illness:
• LUTS Since Jan/Feb 2020. Past History Nil
Physical Examination
• PS 1
Clinical Notes/Old Reports
• TURP conducted on 22 June 2020
• PSA (post TURP): 258.47
• Biopsy: Adenocarcinoma Prostate
• Gleason Score (4+5=9) PNI present
• PSMA-PET: Prostatic Lesion with Peri prostatic Stranding. Presacral Soft Tissue with invasion of posterior and left lateral rectal wall. Multiple pelvis and RP lymph nodes. Multiple osseous sclerotic lesions
• Started on Degarelix and Denosumab (1 July 2020)
• MRI LS spine: Multiple metastatic focal lesions in LS vertebrae and bilateral iliac bones.
•Dexa Scan done on 20 October 2020: Normal T score-2.9.
• Genetic testing: BRCA1, BRCA2 Negative.
Tumor Markers
•27 June 2020 (Post TURP): 258.47 ng/ml
•28 July 2020: (After 1st cycle): 7.87
•23 Sept 2020: (After 3rd cycle): 0.88
•18 Dec 2020:(After 6th cycle) 0.10
Treatment
• Degarelix (80mg), Denosumab(120mg) (monthly injection) + daily Abiraterone (1000 mg) and Prednisone (5 mg)
Current Status
•PSMA PET SCAN conducted on 16 Dec 2020
•Findings
oNear complete resolution of large, ill marginated PSMA, avid hypodense lesion in left lobe of the prostrate and complete resolution of the peri prostatic stranding.
oComplete Resolution of:
PSMA avid presacral soft tissue thickening.
A few sub centimetre size, F 18 PSMA avid bilateral retro- crural lymph nodes.
All but one of the multiple PSMA avid para ortic, aortocaval, bilateral common iliac , internal and external iliac, and para rectal lymph nodes.
PSMA avid predominantly, sclerotic lesions, in multiple osseous structures and reactionary sclerosis in the underlying bones.
Multiple, up to centimetre size, most of these partly calcified and some non-calcified , para trachial , pre carinal , sub carinal and AP window nodes.
PSMA avid , right hilar and a left para bronchial nodes.
Non PSMA avid , likely inflammatory mucosal thickening in right maxillary sinus.
Scan findings are suggestive of very good response to therapy .
Prognosed Treatment
•Degarelix 80 mg (monthly)
•Denosumab 120 mg (monthly)
•Abiraterone 1000 mg (Daily)
•Prednisone 05 mg ( Daily )
If any one has any suggestions/ comments , to make they are welcome.
😀😀