Hormone Therapy in Prostate Cancer

Abstract

The role of nuclear medicine diagnostic bone scanning is well established in prostate cancer. This case provides an insight into the specific role that bone scanning plays in monitoring response to hormone therapy and an example of significant global skeletal response. The case highlights the remarkable efficacy of timely hormone therapy in high-grade prostate cancer with widespread bony metastasis. In addition, the range of hormone therapy currently available for clinical application in the management of metastatic prostate cancer is detailed. Finally, the case represents an incidental diagnosis of prostate cancer after evaluation of nonspecific symptoms. We present a case study that provides an insight into the specific role that bone scanning plays in monitoring response to hormone therapy. The case highlights the remarkable efficacy of timely hormone therapy in high-grade prostate cancer with widespread bony metastasis. CASE REPORTAn 83-y-old man presented for evaluation of reported weight loss and constipation. These symptoms were initially assessed by CT of the chest, abdomen, and pelvis. The findings were unremarkable, although a left renal staghorn calculus was noted. Despite no previous history of neoplasia, extensive sclerotic lesions were noted throughout the axial skeleton. This finding, combined with the observation of an irregular prostate contour (without enlargement), raised suspicion of previously undiagnosed widespread metastatic prostate carcinoma. Subsequent follow-up revealed a prostate-specific antigen (PSA) level of 823 mg/L (normal, ,4 mg/L) and bone scan findings consistent with widespread skeletal metastases (Fig. 1). Subsequent prostate biopsy confirmed aggressive prostate carcinoma with a Gleason score of 9 (1). The patient commenced hormone therapy using bicalutamide (150 mg; Cosudex [AstraZeneca]) daily (oral tablet) and leuprorelin (30 mg; Lucrin [AbbVie]) depot (intramuscular injection) every 4 mo. The medications were well tolerated. At week 4, goserelin (Zoladex; AstraZeneca), a 10.8-mg subcutaneous implant (1 dose at 3 monthly intervals), was added to the patient's antitumor therapeutic armamentarium.At 5 mo after the commencement of therapy, the PSA level had normalized to 0.39 ug/L. It dropped further to 0.11 mg/L at 10 mo, corresponding to scintigraphic resolution of bony metastatic changes on the follow-up nuclear medicine bone scan (Fig. 2).

New Routine for Nuclear Medicine Technologists to Determine When to Add SPECT/CT to a Whole-Body Bone Scan

“…The main indication for bone scintigraphy is to detect bone metastases as early as possible and to evaluate problems with malignant bone involvement such as pathologic fractures or degenerative changes (4,5). The most common localization site of malignant tumors is the skeleton, followed by the lungs and the liver (6).…”