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PROSCA 2019 - case 4

Your case challenge (apply data presented at ASCO 2019)

Jean-Michel is a 68-year old journalist at French TV specialised in European politics and business. He plays tennis 3 times a week and has an intense sexual life. He was diagnosed with prostate cancer 7 years ago due to high total PSA (6.8 ng/ml at that time) with no significant past history, except a minor surgery for inguinal left hernia 14 years ago. His father was treated for laryngeal cancer at the age of 73.

At diagnosis, his PCa presented as:

  • Clinical stage: cT2b, prostate MRI negative for extra-prostatic extension and/or seminal vesicles invasion
  • PSA: 6.8 ng/ml
  • Biopsy Gleason score: 3+4 [ISUP grade group 3]
  • Negative bone and pelvic CT scan
  • ECOG performance status: 0

He underwent radical prostatectomy with no pelvic lymph node dissection.

Final pathology:

  • Adenocarcinoma of the prostate
  • Gleason score 3+4 of the left lobe
  • Margins positive on 2 mm at the left apex

Postop PSA was < 0.004 ng/ml.

He regained full urinary continence 4 months after surgery, and was prescribed a treatment with Viagra. An expectant policy was adopted with PSA controls every 3 to 6 months.

Seven years after his surgery, he comes for a second opinion because of a rising PSA.

  • Two years ago: PSA 0.05 ng/ml
  • 18 months ago: 0.09 ng/ml
  • 15 months ago: 0.12 ng/ml
  • 12 months ago: 0.17 ng/ml
  • 8 months ago: 0.19 ng/ml
  • Recently: PSA 0.21 ng/ml, controlled at 0.26 ng/ml

What would you tell him?