PMC7450451_01
Prostate serum antigen (PSA) and corresponding prostatic tumor size
across patient's treatment course. Measured PSA (boxes) with
trend line (solid black line) across the patient's treatment
course with corresponding prostate tumor size by magnetic
resonance imaging at the time of treatment switch or at PSA
nadir. Above the graph displays the systemic treatments and
specific radiation treatment the patient received. The duration
of each systemic therapy is the time interval between dotted
grey lines. Note, the patient has continued to receive
leuprolide every 3 months since June 2017.. EBRT, external beam radiation therapy; SBRT, stereotaxic body
radiotherapy
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He was initially treated with leuprolide, abiraterone, and prednisone from June to November 2017, but PSA rose and the primary tumor size increased within four months of treatment initiation, consistent with development of castration resistance (Figure 1). Systemic carboplatin and docetaxel was trialed for 2-3 months with minimal PSA response and interval imaging in January 2018 revealed worsening disease (Figures 1 and 2(a) and (b)). Restaging MRI pelvis in December 2018 revealed an enlarging primary tumor size, worsening seminal vesicle involvement, rectal invasion, and a right pubic bone lesion without other measurable soft tissue lesions by Response Evaluation Criteria in Solid Tumors (RECIST) criteria (Figures 1 and 2(e) and (f)).
Serial magnetic resonance imaging pelvis imaging of the patient's
tumor after sequential treatments.. Axial and sagittal views of the patient's primary tumor at
different stages of treatment: (a) and (b) prior to the first
course of radiation and cabazitaxel/carboplatin; (c) and (d)
after completing four cycles of carboplatin, cabazitaxel, and
SBRT for total dose of 3800 cGy; (e) and (f) at the time of
tumor recurrence prior to pembrolizumab initiation and second
course of radiation; and (g) and (h) after six cycles of
pembrolizumab and re-irradiation. There was a marked response to
each treatment course with ~100-fold reduction in total tumor
volume (outlined in dashed line).
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Systemic carboplatin and docetaxel was trialed for 2-3 months with minimal PSA response and interval imaging in January 2018 revealed worsening disease (Figures 1 and 2(a) and (b)). Chemoradiation decreased primary tumor size and PSA by >90% after four cycles (Figure 2(c) and (d)). Restaging MRI pelvis in December 2018 revealed an enlarging primary tumor size, worsening seminal vesicle involvement, rectal invasion, and a right pubic bone lesion without other measurable soft tissue lesions by Response Evaluation Criteria in Solid Tumors (RECIST) criteria (Figures 1 and 2(e) and (f)). In April 2019, after RT and six cycles of pembrolizumab, the patient's PSA was undetectable and imaging revealed a decreased prostatic mass with no radiographic evidence of rectal wall involvement (Figure 2(g) and (h)).