Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4985
Peer-review started: October 30, 2021
First decision: February 14, 2022
Revised: March 4, 2022
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: May 26, 2022
Processing time: 206 Days and 9.8 Hours
The 2020 European Association of Urology prostate cancer guidelines recommend androgen deprivation therapy (ADT) in combination with apalutamide and enzalutamide, a new generation of androgen receptor antagonists, as first-line therapy. A decrease in prostate-specific antigen (PSA) levels may occur in the early stages of novel hormonal therapy; however, radionuclide bone imaging may suggest disease progression. During follow-up, PSA, radionuclide bone imaging, and prostate-specific membrane antigen (PSMA) positron emission tomography – computed tomography (PET-CT) are needed for systematic evaluation.
We admitted a 56-year-old male patient with metastatic hormone-sensitive prostate cancer. Initial radionuclide bone imaging, magnetic resonance imaging (MRI), and PSMA PET-CT showed prostate cancer with multiple bone metastases. Ultrasound-guided needle biopsy of the prostate revealed a poorly differentiated adenocarcinoma of the prostate with a Gleason score: 5+4 = 9. The final diagnosis was a prostate adenocarcinoma (T4N1M1). ADT with novel hormonal therapy (goseraline sustained-release implant 3.6 mg monthly and apalutamide 240 mg daily) was commenced. Three months later, radionuclide bone imaging and MRI revealed advanced bone metastasis. However, PSMA PET-CT examination showed a significant reduction in PSMA aggregation on the bone, indicating improved bone metastases. Considering that progressive decrease in the presenting lumbar pain, treatment strategies were considered to be effective.
ADT using novel hormonal therapy is effective for treating patients with prostate adenocarcinoma. Careful evaluation must precede treatment plan changes.
Core Tip: In 2018, prostate cancer was ranked as the fifth leading cause of cancer-related deaths in men, worldwide. Some of such cases are metastatic hormone-sensitive prostate cancers (mHSPC) and Apalutamide has been shown to improve survival in such patients. However, a “bone-flare” phenomenon may occur during management with apalutamide. We describe a case of mHSPC with this phenomenon after apalutamide and androgen deprivation therapy, and thus demonstrate the importance of multiple bone imaging modalities, radionuclide bone imaging, magnetic resonance imaging, prostate-specific antigen, prostate-specific membrane antigen positron emission tomography – computed tomography, in determining the treatment course in such patients.