Dr. Stephen Freedland's Case Study

Read Through the Following Patient Treatment History to See What Treatment Option Dr. Stephen Freedland Selected at Each Line of Therapy

Dr Stephen

Not actual patient.

Dr. Stephen Freedland's
Case Study

Initial Presentation1

  • Age 66
  • PSA 4.63 ng/mL
  • DRE showed large nodules on both sides of prostate
  • Family history of prostate cancer (father)
  • BMI 28.0 and hypertension
  • TRUS biopsy—12 core: 4/6 cores with Gleason grade 4+4=8 on the right, 0/6 cores on the left
  • Metastatic imaging negative—CT and bone scan
  • cT2c, Gleason grade 8, PSA 4.63 ng/mL (high risk)

Patient Treatment History


Initial Management1

  • Underwent retropubic prostatectomy
    • Pathology showed pT3a, +margins, Gleason grade 4+3=7 (grade group 3) in both lobes
    • Nodes negative
  • Recovered well and initial PSA <0.2 ng/mL
  • Post-op PSA undetectable and remained so for 5 years, until it started to rise to 0.2 ng/mL
  • By 67 months, PSA was 0.53 ng/mL
    • PSADT was 3.3 months
  • Repeat imaging was negative


  • Underwent XRT alone; PSA decreased to 0.3 ng/mL
  • PSA began to rise and by 87 months was 2.43 ng/mL
    • PSADT was 5 months
  • Repeat imaging was negative
  • Started on androgen deprivation therapy (ADT) (leuprorelin) every 3 months
  • PSA decreased to undetectable until 5 months later when it began to rise
  • 16 months after starting ADT, PSA reached 3.0 ng/mL
    • Now CRPC
    • PSADT was 4 months
  • Repeat imaging was negative

Subsequent Management:

  • Given short duration of ADT response and short PSADT, patient initiated on enzalutamide 160 mg

Patient's disease progressed to nmCRPC

First-Line Therapy: Enzalutamide + Prednisone1

Response to Treatment:

  • PSA down to undetectable
  • Tolerated it well with some mild fatigue

Disease Progression:

  • 12 months later PSA started to rise to 1.0 ng/mL
  • Repeat imaging showed bone metastases at S1 and L2
  • Asymptomatic
    • Patient has progressed to mCRPC and is started on Enzalutamide 75 mg/m2 every 3 weeks and prednisone
    • ADT is maintained throughout mCRPC treatment

Patient's disease progressed to mCRPC

Second-Line Therapy: Docetaxel + Prednisone1

Response to Treatment:

  • Waited a little while off treatment post-enzalutamide, but then started on docetaxel
  • Pre-chemo PSA was 12 ng/mL
  • PSA decreased to 8 ng/mL
  • Only tolerated 6 cycles of docetaxel
    • Discontinued treatment due to neuropathy

Dr. Stephen Freedland's Treatment Choice: JEVTANA

Read Below to See Why Dr. Stephen Freedland Chose JEVTANA as the Next Line of Therapy for His Patient

Treatment selection1

Patient started on JEVTANA 20 mg/m2 every 3 weeks and prednisone.

RATIONALE for Treatment2

Based on patient disease characteristics and treatment progression, Dr. Freedland referred to the CARD trial. In the CARD trial, JEVTANA provided 2x rPFS vs a second ASTI.

Clinical Outcome and Follow-Up1

  • Patient held off on treatment for a period before starting JEVTANA, due to bad experience with docetaxel
  • Started to get new back pain requiring radiation
  • Pre-chemo PSA was 30 ng/mL
  • Tolerated 10 cycles of JEVTANA
  • AEs
    • Grade 1 neutropenia
    • Grade 1 diarrhea, resolved with a low-residue diet
  • PSA down to 8 ng/mL; pain resolved
  • Decided to take a drug holiday
  • Patient was counseled on all possible AEs. Please refer to Prescribing Information for full list of potential AEs

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.

AEs=adverse events; ASTI=androgen-signaling-targeted inhibitor; BMI=body mass index; CT=computed tomography; DRE=digital rectal exam; mCRPC=metastatic castration-resistant prostate cancer; nmCRPC=nonmetastatic castration-resistant prostate cancer; PSA=prostate-specific antigen; PSADT=prostate-specific antigen doubling time; rPFS=radiographic progression-free survival; TRUS=transrectal ultrasound guided; XRT=radiotherapy.