Father in law, stage 4
Prostate cancer, Clinical: Stage IV (T2c, N1, M1c)
Stage IV (T4, NX, M1c, Gleason 8-10)
a 77 y.o. male, diagnosed with adenocarcinoma of the prostate with metastatic lesions to the bone and local bladder invasion, who initially was seen by Dr. in Urology for urinary symptoms, including frequency, urgency and incomplete emptying. At that time his PSA was elevated at 34.1. He also had an abnormal digital rectal examination with findings of an enlarged prostate. He underwent a transrectal ultrasound-guided biopsy of his prostate gland which showed prostate adenocarcinoma. He also had left iliac lymph node biopsy consistent with poorly differentiated adenocarcinoma with prostate primary. This was followed by CT scan of the abdomen and bone scan. The CT abdomen confirmed an enlarged prostate, as well as nodular hyperdensities in the bladder lumen and borderline enlarged iliac chain lymph nodes bilaterally. Patient underwent cystoscopy and bladder mucosa biopsy on 11/24/2015, which was positive for prostate adenocarcinoma.
Patient completed 6/6 doses of Taxotere on 4/15/16.
He remains on lupron, changed from 22.5 mg Q3 months to 7.5 mg monthly in December 2016.
He had restaging scans with CT C/A/P and bone scan on 2/26/18, which found no progression of disease. He was seen on 8/24/2018 and his PSA level was seen to be increasing. He was started on Xtandi at that time. After insurance approval, he started the pills on 9/2/18. He began having worsening fatigue so he decreased dose to 120 mg and continued with monthly Xgeva and Lupron..
He began having yet again worsening fatigue and has decided to stopped therapy with Xtandi in early September 2019. His PSA began to rise and he started treatment with Apalutamide on 1/15/2020, but discontinued in June 2020 after developing a rash. Foundation One testing was done and resulted showing that he would benefit from a PARP inhibitor and therefore started treatment with Olaparib on 8/20/2020. He was having difficulty with diarrhea and was dose reduced to 75 mg PO BID on 10/13/2020. He later completed palliatve radiation therapy to the prostate and inferior ramus on 01/20/2021. The Olaparib was then increased to 200 mg PO BID in January 2021 following completion of radiation. He began having significant aside effects including headaches and diarrhea and per the patient's request the medication was discontinued on 6/29/2021. Since stopping, his previous symptoms has resolved.
He underwent restaging scans in July 2021. He was noted to have new foci of osteoblastic metastatic disease in the left scapula and left proximal femur on bone scan. On CT scan of the chest/abdomen/pelvis there was progressive osteosclerosis in the left pelvis suggesting osseous metastases. Decision was made to switch therapy to Jevtana with prednisone. He received his first dose on 8/27/2021 and has also continued xgeva and lupron every 3 months.
Interim History: Patient presents to clinic today for follow up. He is feeling okay, but "lousy" compared to last few visits. He mentions that he was recently having issues again with blood in his urine. He followed up with his Urologist and had to increase the size of his catheter. That seemed to help a bit. He has been having issues with both constipation and diarrhea. His appetite is stable. No recent fever. He feels overall fatigued. Denies any pain on today's visit. He would like to still pursue treatment today but wanted to review scans at next visit and based on results, pursue just lupron alone. He does not wish to continue with chemotherapy after today.
Past Treatment:
- Docetaxel x 6 cycles 12/29/2015- 4/15/2016
- Xtandi 9/2/2018- 9/2019
- Apalutamide 1/15/2020- June 2020
- Olaparib 150 mg PO BID started on 8/20/2020, dose reduced to 75 mg PO BID on 10/13/2020, discontinued due to side effects on 06/29/2021
- palliative RT to prostate and inferior ramus on 1/20/2021
Current Treatment:
- Cabazitaxel/ prednisone started 8/27/2021
- Lupron every 3 months
- Xgeva every 3 months
Past Medical History:
Diagnosis
Date
•
Acute blood loss as cause of postoperative anemia
10/31/2018
•
BPH (benign prostatic hyperplasia)
•
CAD (coronary artery disease)
2012
LAD stent in New York. 2nd DES distal to previous stent 4/2018.
•
Cancer
Prostate
•
DDD (degenerative disc disease), lumbar
•
DDD (degenerative disc disease), lumbar
•
Duodenal ulcer
Perforation
•
GERD (gastroesophageal reflux disease)
•
Hematuria, gross
•
NSTEMI (non-ST elevated myocardial infarction)
4/17/2018
•
OSA on CPAP
does not use cpap
•
Osteoarthritis
•
Perforated ulcer
1995
•
Prostate cancer metastatic to bone
Stage IV adenocarcinoma of prostate T4N1M1b with bone mets and local bladder invasion
Lab Review
Office Visit on 12/10/2021
Component
Date
Value
Ref Range
Status
•
White Blood Cell
12/10/2021
5.5
4 - 10 10*3/uL
Final
•
Red Blood Cell
12/10/2021
4.13*
4.6 - 6.1 10*6/uL
Final
•
Hemoglobin
12/10/2021
11.6*
13.5 - 18 g/dL
Final
•
Hematocrit
12/10/2021
35.8*
41 - 53 %
Final
•
Mean Cell Volume
12/10/2021
86.6
80 - 96 fL
Final
•
Mean Cell Hemoglobin
12/10/2021
28.1
27 - 33 pg
Final
•
Mean Cell Hgb Conc
12/10/2021
32.4
32.0 - 36.0 g/dL
Final
•
Red Cell Dist Width
12/10/2021
17.5*
11.5 - 14.5 %
Final
•
Platelet Count
12/10/2021
294
150 - 400 10*3/uL
Final
•
Differential Type
12/10/2021
Automated Diff
Final
•
Neutrophil
12/10/2021
76
%
Final
•
Lymphocyte
12/10/2021
12
%
Final
•
Monocyte
12/10/2021
9
%
Final
•
Eosinophil
12/10/2021
1
%
Final
•
Basophil
12/10/2021
2
%
Final
•
Abs Neutrophil
12/10/2021
4.17
1.8 - 7.0 10*3/uL
Final
•
Abs Lymphocyte
12/10/2021
0.66*
1.2 - 4.0 10*3/uL
Final
•
Abs Monocyte
12/10/2021
0.52
0 - 0.8 10*3/uL
Final
•
Abs Eosinophil
12/10/2021
0.08
0 - 0.5 10*3/uL
Final
•
Abs Basophil
12/10/2021
0.09
0 - 0.2 10*3/uL
Final
•
Nucleated Red Blood Cells
12/10/2021
0
0 - 0 /100
Final
Tumor Markers
Lab Results
Component
Value
Date
PSATOTAL
57.9 (H)
11/19/2021
PSATOTAL
52.5 (H)
10/29/2021
PSATOTAL
44.6 (H)
10/08/2021
My questions are mainly from my wife;
Such as what should we expect?
Will this be quick or will they have more time?
Given the numbers, I am unsure of how to read the projections and the oncologist said in August that WITH chemo 6 months to a year and without chemo 6 months or less (but the doctor had his eyes closed and his head back while saying this so....I dunno)
Even during the course of chemo therapy his PSA continues to rise[and by rise i mean go up and then go up by double what it was and so on...such as goes from like 50 to 60, then 75, 85, 105, etc]
Father in law is having to self cath that in the past two weeks went from every 3 hours round the clock to every hour and a half, two hours max and is having a lot of pain in area of the kidneys when the urgency to urinate presents and also when the bladder contracts to evacuate. He seems very dehydrated. He's passing a lot of clots in his urine and feces (come about an inch and a half long) and urology states the urinalysis shows no infection and that the clots might be due to the bladder being irritated and they suggested a suprapubic permanent catheter (which my FIL was very against, but during his tele-med appointment friday he has decided to try the SP cath and urologist is scheduling this)
He hasn't eaten anything as the nausea, dizziness, and vomiting have become too intense. He is also on a pendulum of constipation and diarrhea and these side effects are worse after the second round of 6 chemo treatments.
What are we looking at here? What sort of projections do you estimate? Will he "get better"....as in will this nausea, dizziness, vomiting, bowel trouble ease up or will other symptoms arise and/or persist?
sorry for the wall of text, but you all have been very helpful and supportive and in this current leg of the disease, we are all trying to figure what comes next or what to anticipate...and dare I say if any of these bouts/stages normal; Father in law has a DNR in place and we're trying to make him as comfortable as we can, but my wife worries about how his illness will affect our five year old as father in law lives in the house with us)
looking for next steps for my young husband
No More Orgovyx, Continuing with Abiraterone and Prednisone
Psa rising and on Lupron. Thinking about castration and looking for advice. 
Looking for 2nd opinion at Duke re new bladder cancer
