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Table 1 Timeline

From: Pain, PSA flare, and bone scan response in a patient with metastatic castration-resistant prostate cancer treated with radium-223, a case report

Date PSA (ng/mL) Imaging Bone pain level Therapy
February 2008 14.8 Single bone metastasis in left pubic ramus None  
June 2008 20.1   None ADT initiated
October 2008 0.2   None  
June 2010 8.0 Progression: increase in the extent of abnormal radiotracer activity within the left acetabulum and left superior pubic ramus None Phase I study of BN83495 (DHEAS inhibitor)
July 2010 13   Moderate Taken off study for PSA progression; Palliative radiation to pelvic bone metastasis for left hip pain
December 2010-January 2010    None Sipuleucel-T immunotherapy
February 2011   Progression: new osseous metastases; no visceral metastases None  
April 2011 54.8   None  
May 2011   Progression: new osseous metastases; no visceral metastases None  
June 2011    None Phase III study of CYP17 inhibitor plus prednisone (randomized to CYP17 inhibitor arm)
October 2011 126.4 Progression: new osseous metastases; no visceral metastases Moderate Taken off study for symptomatic disease progression
January 2012-July 2012 234 (January) 46.95 (July)   Moderate → mild 10 cycles of docetaxel chemotherapy plus prednisone
August 2012 and October 2012   Stable osseous metastatic disease; no visceral metastases Mild  
December 2012 128   Moderate Palliative radiation to a sacral osseous metastasis for low back pain
January 2013 331   Mild Enzalutamide initiated
February 2013 224   Mild  
July 2013 653 Progression of osseous metastatic disease; no visceral metastases Severe diffuse bone pain  
August 2013 996   Pain flare for 10 days after 1st dose of radium-223 1st dose of radium-223
October 2013    Pain significantly improved, discontinued opioids  
November 2013    Mild pain controlled with NSAIDs Symptomatic anemia, requiring transfusion. Has remained transfusion-dependent since.
December 2013    Mild pain controlled with NSAIDs 6th dose radium-223
January 2014 554   Mild pain controlled with NSAIDs  
February 2014   Dramatic bone scan response to radium-223 with significant decrease in activity of all skeletal metastases Mild pain controlled with NSAIDs  
January-July 2014 Stable at about 600   Mild pain controlled with NSAIDs  
July 2014 780 Out-of-field disease progression: new diffuse osseous metastases in the skull, no change in previously existing metastatic disease Headache; Bone pain stable (mild) Steroids and stereotactic radiation to skull base mass