Delayed Diagnosis of Recurrent Prostate Cancer Leads to Bony Metastasis

Case Overview

This case involves a 55-year-old male patient who was diagnosed with Stage II prostate cancer. The initial pathology reports revealed an adenocarcinoma throughout the prostate, with Gleason scores of 8 in all regions. A bone scan at the time revealed no evidence of metastatic disease and surgery was not recommended by his oncologist, but rather external beam radiation (IMRT and androgen deprivation therapy were offered. The patient elected for IMRT therapy alone, without the androgen deprivation. The patient tolerated the treatment well with the exception of frequent nocturia and a constant feeling of incomplete emptying. He took several medications to deal with these issues, including Flomax. In the years that followed, several follow-up PSAs were obtained, however, no form of surveillance imaging was ordered by his radiation oncologist. A random PSA was done was taken by the patients PCP and it spiked to a value of 75, which finally prompted further investigation. At this time, the radiation oncologist ordered a full workup, including a bone scan and a CT of the abdomen and pelvis. The bone scan showed widespread metastatic disease to the spine, ribs, shoulders and pelvis.

Questions to the Radiation Oncology expert and their responses

Does the standard of care require surveillance imaging as part of the follow-up protocol for a patient with this profile?

Stand alone imaging is not standard of care for following prostate cancer in remission. PSA would be the best way to follow a patient initially. Current guidelines call for PSA to be done every 6 to 12 months for 5 years after the original insult. A PSA rise of 2 over the lowest recorded level would trigger the need for further imaging.

About the expert

This expert has over 50 years of experience in both academic as well as professional clinical settings as a clinical radiation oncologist. She is a leader in her field, having received special appointments such as chairman, board of trustees, advisory board for various university and community hospitals. Moreover, she actively pursues research and is widely published in topics including radiation therapy and oncology. She is a board certified member of the American Board of Radiology with certification in Therapeutic Radiology and Radiation Oncology.

E-000027

Specialties:

Radiation Oncology

Michael Talve stands at the forefront of legal innovation as the CEO and Managing Director of Expert Institute. Under his leadership, the Expert Institute has established itself as a vital player in the legal technology arena, revolutionizing how lawyers connect with world-class experts and access advanced legal technology. Michael's role involves not only steering the company's strategic direction but also ensuring the delivery of unparalleled intelligence and cutting-edge solutions to legal professionals. His work at Expert Institute has been instrumental in enhancing the capabilities of attorneys in case preparation and execution, making a significant impact on the legal industry's approach to expert consultation and technological integration. Michael's vision and execution have positioned the Expert Institute as a key facilitator in the intersection of law and technology.