Table 2.
Novel method of uniform prostate cancer nomenclature
| Principle |
|
|
|---|
| Nomenclature provides a succinct and individualized summary of CaP androgen-responsiveness, treatment history and disease progression. |
|
|
| Examples |
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|
| Case #1 |
| A 68 year old man presents with Gleason grade 5+5=10 CaP and serum PSA 1,000 ng/ml. He receives continuous ADT using leuprolide acetate and bicalutamide. Superscan and serum PSA values demonstrate no response to treatment. |
| Summary: This case represents a truly castration-resistant CaP. Castration-resistant CaP is rare; only 2 to 3 % of newly diagnosed CaP fit this description. |
| Recommended nomenclature: LHRH-resistant and bicalutamide-resistant CaP |
| Case #2 |
| A 68 year old man presents with metastatic CaP and serum PSA value 100 ng/ml 8 years after RP for Gleason grade 3+3=6 organ-confined disease. An induction course of leuprolide acetate causes his serum PSA levels to become undetectable and his bone scan to normalize. Five years later, his serum PSA level starts to rise. He is placed on intermittent ADT using leuprolide acetate for PSA parameters >20 and <1. He responds to each of several cycles, however the responses diminish until his CaP no longer responds to ADT. |
| Summary: This case represents an exquisitely androgen-responsive CaP that responds well to several cycles of ADT until the CaP becomes unresponsive to even continuous ADT. |
| Recommended nomenclature: RP-recurrent, LHRH agonist-recurrent, intermittent LHRH agonist-recurrent CaP |
| Case #3 |
| A 68 year old man presents with metastatic CaP and serum PSA 100 ng/ml 2 years after RP for Gleason grade 4+3=7 pT3bN0M0 disease. He is administered continuous ADT in the form of leuprolide acetate. PSA declines but, six months later, serum PSA levels start to rise. He is administered antiandrogens using bicalutamide. PSA declines but, six months later, serum PSA levels start to rise. After discontinuation of bicalutamide, he experiences antiandrogen withdrawal syndrome, until his PSA levels rise again 4 months later. He is administered docetaxel until serum PSA levels rise 6 months later. He is given abiraterone acetate; PSA declines but, 6 months later serum PSA levels start to rise. He is administered enzalutamide. Five months after an initial response, PSA levels start to rise. He is administered Sipuleucil-T; 6 months after the start of treatment, PSA levels start to rise again. |
| Summary: This case represents a CaP that initially responds to and ultimately fails multiple ADT and other therapeutic approaches. |
| Recommended nomenclature: RP-recurrent, LHRH agonist-recurrent, bicalutamide-recurrent, docetaxel-recurrent, abiraterone acetate-recurrent, enzalutamide-recurrent, Sipuleucil-T-recurrent CaP |