CONCLUSIONS: MRI of axial skeleton enables precise
measurement and follow-up of bone metastases as it is for other
Pending the results of the above would then make treatment decisions
re ADT (androgen deprivation therapy) and how best to give.
If Combidex were still available would do after a normal MRI-A (MRI
axial skeleton) study. If MRI-A (MRI axial skeleton) could not be
done then I would opt for PET/CT using F18 but NOT FDG isotope.
I would also want baseline testosterone level as well as prolactin
level and given the uncertainty of the Gleason score would want
neuroendocrine (NE) markers that are more often seen with high
Gleason scores of 8-10 such as CGA (Chromogranin A), NSE (Neuron
Specific Enolase) and CEA (Carcinoembryonic Antigen). Read The
Primer on Prostate Cancer by Strum & Pogliano and see page 64
regarding markers in high GS situations.
Assuming all has been done, ADT should be at least ADT with 3 drugs
to include anti-androgen (AA) e.g. Casodex or Flutamide followed one
week later by an LHRH agonist like Lupron or Trelstar or Eligard. I
also use Avodart along with the anti-androgen (AA). I monitor the
CBC, ultrasensitive PSA, CMP (comprehensive metabolic panel) &
testosterone monthly until stable values. My goal in PSA is < 0.05 x
12 months and then off ADT but staying on Avodart.
Our published paper used finasteride (Proscar) but dutasteride
(Avodart) appears to be a more appropriate 5ARI (5-alpha reductase
inhibitor) for higher Gleason score PC