External beam radiotherapy in treatment of high-volume metastatic hormone-sensitive prostate cancer: clinical case

The standard treatment for metastatic hormone-sensitive prostate cancer does not include external beam radiotherapy (EBRT) and radionuclide therapy with radium-223.

The article describes a clinical case of successful use of EBRT and radionuclide therapy with radium-223 in a patient with primary high-volume metastatic hormone-sensitive prostate cancer.

The patient  received diagnosis of prostate cancer сT3bN1M1b (Gleason score 8 (4 + 4)), stage IV (metastases in the bones, extraperitoneal and intrathoracic lymph nodes; prostate specific antigen (PSA) level was 4280 ng/mL). Between October of 2017 and January of 2018, the patient received 6 cycles of chemohormonal therapy (degarelix + docetaxel). Bilateral orchiectomy was performed on 05.02.2018, and the patient underwent palliative EBRT on cervical vertebrae between 04.10.2017 and 19.10.2017 with total dose of 32.6 Gy (equivalent to 38.5 Gy). The patient received systemic radiotherapy with one injection of samarium oxabifor (153Sm) 40 mCi (21.03.2018) and radium-223 (4 injections once a month (17.04.2018, 15.05.2018, 14.06.2018, 10.07.2018) + 2 injections 1 time per 3 months (October 2018, January 2019)). Partial response was achieved in the form of PSA decrease from 4280 ng/mL (September 2017) to 0.505 ng/mL (May 2019). Palliative EBRT for the prostate and pelvis was performed between 14.11.2018 and 19.12.2018 for total dose of 62.5 Gy (equivalent to 69 Gy). For 2 years remission was observed with PSA level of 0.3–0.5 ng/mL. In December of 2020, biochemical recurrence was diagnosed: PSA level increased from 0.61 ng/mL in October to 1.43 ng/mL on  28.12.2020.  The  second  course  of  radionuclide  therapy  with  radium-223  5,500  MBq/mL  was  performed  (22.01.2021, 05.03.2021, 02.04.2021) with increase of PSA level to 1.92 ng/mL (May of 2021) and independent decrease to 0.542 ng/mL (June of 2022). In December of 2022, biochemical recurrence was observed with a small increase of PSA level to 1.67 ng/mL. Currently, the disease is stabilized.

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