Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2022; 10(15): 4985-4990
Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4985
Bone flare after initiation of novel hormonal therapy in patients with metastatic hormone-sensitive prostate cancer: A case report
Ke-Hao Li, Yuan-Cheng Du, Dong-Yu Yang, Xin-Yuan Yu, Xue-Ping Zhang, Yong-Xiang Li, Liang Qiao
Ke-Hao Li, Yuan-Cheng Du, Dong-Yu Yang, Xin-Yuan Yu, Department of Clinic, Weifang Medical University, Weifang 261000, Shandong Province, China
Xue-Ping Zhang, Yong-Xiang Li, Liang Qiao, Department of Urology, Weifang People's Hospital, Weifang 261000, Shandong Province, China
Author contributions: Li KH reviewed the literature, and contributed to manuscript drafting; Du YC, Yu XY and Li YX contributed to manuscript drafting; Zhang XP and Yang DY obtained informed consent; Qiao L was responsible for the revision of the manuscript; and All authors gave final approval for the submitted version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Liang Qiao, MD, PhD, Chief Doctor, Professor, Department of Urology, Weifang People's Hospital, No. 151 Guangwen Street, Kuiwen District, Weifang 261000, Shandong Province, China. lysanjin@163.com
Received: October 30, 2021
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

ADT using novel hormonal therapy is effective for treating patients with prostate adenocarcinoma. Careful evaluation must precede treatment plan changes.

Keywords: Bone flare; Novel hormonal therapy; Metastatic hormone-sensitive prostate cancer; Apalutamide; Case report

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.