80 yr old, diagnosed 2020. The best of my knowledge 2 small bone mets, one from initial diagnosis, one from last scan in nov
Prostate cancer, stage IV with bone metastases. Germline/somatic mutational testing negative for BRCA1/2 and MSI stable. TMB not evaluated. PSA rising with a doubling time of 4.5 months on darolutamide. New focus of increased uptake in the right ninth posterior rib, consistent with metastatic disease seen on bone scan 11/9/22. No new metastatic lesion seen on CT of the chest/abdomen/pelvis on the same day.
Prostate cancer 6/2020 stage IV (cT2a cN0 cM1b), Gleason 4+4, PSA 110, multiple bone mets
-ADT with Lupron 7/2020 PSA declined from 110 to 8, increasing to 25 in 12/2020.
-rising PSA and declining urinary function 1/2021, enzalutamide instituted with excellent initial PSA response but cognitive decline necessitating 50% dose reduction. PSA rising late 2021.
-denosumab 60 mg every 3 months 2021
-transition 1/2022 to darolutamide 600 mg twice daily due to cognitive dysfunction and tremors on enzalutamide. Darolutamide better tolerated but intermittent right arm tremors.
- Germline/somatic mutational testing negative for BRCA1/2 and MSI stable. TMB not evaluated. Variants of uncertain clinical significance include EZH2 C289Y and MET H542H.
