Table 1 Timeline
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 |