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