Case 10 Newly diagnosed metastatic prostate cancer

In unscreened populations, approximately 16% of men with newly diagnosed prostate cancer have metastatic disease. The optimal treatment for such patients is combination therapy with androgen deprivation combined with either docetaxel, abiraterone, enzalutamide, or apalutamide. In patients with low metastatic burden (only non-regional lymph node metastasis or fewer than four bone metastases and no visceral metastasis), prostate radiotherapy combined with systemic treatment improves survival. Selection between these treatments depends on patient comorbidity and preference, availability of drugs, side effects, and metastatic burden. Eventually, disease progression occurs in the majority and treatment sequencing thereafter depends on patient comorbidity and preference, previous therapies, drug availability, side effects, sites and extent of metastases, and, now, the presence of genomic alterations. Bone metastases are the most common secondary site and timely management is required to prevent skeletal complications. Despite optimal treatment, most cases will require palliative support in the disease’s later stages. This case presentation of a man with newly diagnosed metastatic prostate cancer highlights some of the key decisions required in managing this condition.