How do you approach patients with metastatic castrate sensitive prostate cancer who have discrepant PSA and radiographic response to upfront triplet therapy?
Patient presented with diffuse PSMA-avid bone metastases and initial PSA ~500. Received docetaxel/leuprolide/darolutamide. PSA declined to 4.3 after ~6 months of treatment, however he has persistent widespread PSMA-avid osseous lesions with minimal decrease from baseline. Biopsy of a bone lesion confirms prostatic adenocarcinoma without evidence of histologic transformation.
1 Answer
Mednet MemberInvited Expert
Medical Oncology · Veterans Administration Health Care Center
Answered on
The situation where PSA response is discordant from changes in PSMA uptake is always very challenging. In this case, a bone biopsy has shown persistence of adenocarcinoma and absence of small cell transformation. In the SWOG GU committee some years ago, we showed that a > 90% reduction in PSA porten...
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