Condition during hormone therapy: enzalutamid, gozerelin. Condition during photodynamic therapy. Second clinic group. ICD-10 C61
Transrectal prostate biopsy was performed in Ivanovo Regional Hospital. Histological conclusion dated December 27, 2019:: acinar cribriform solid adenocarcinoma. Gleason score (4+4) 8, grade IV. Ready medicines glass 72515-17/19: prostate adenocarcinoma, Gleason sum 8 (4+4) (tumour volume in prostate biopsy 35%).
Radioisotope scanning: whole body osteoscintigraphy-RFP: Pirfotech 99mTc dated 4.02.2020. Intensive inclusion of the medicine into bone structures is seen in the front and rear projections in the scintigrams of the whole body. RFP distribution corresponds to the age norm. Multiple centres of pathological accumulation of RFP are seen in the projections of following bone formations:
Residual radioactivity in kidneys and the urinary tract corresponds to the time of the scanning. Atypical fixation of the medicine in parenchymal organs is absent.
Conclusion: Scintigraphic signs of specific damage of the structures described above.
MSCT of the lesser pelvic organs with IV contrast (iomeron 400 mg–5.0 per os, iomeron 400 mg–80 ml) dated February 25, 2020.
Conclusion: Cr prostatae with invasion into the back wall of the bladder. Mts damage of left and right iliac lymph nodes. Multiple osteoblastic foci in pelvic bones. SBHOVR “Regional Clinical Oncology Hospital” in Vladimir recommends: hormone therapy (enzalutamide 160 mg per day until castrate resistance develops + goserelin 10.8 mg once every 3 months) + bisphosphonates therapy — zoledronic acid 4 mg once every 28 days. The patient does not get medications under the Supplementary Medicines Provision (DLO and RLO).
A medical commission took place. It was decided to carry out the treatment described above: enzalutamide 160 mg daily until castrate resistance develops + goserelin 10,8 mg once every 3 months + bisphosphonates therapy - zoledronic acid 4 mg once every 28 days.
Whole-body osteoscintigraphy dated July 21, 2020: Whole-body scintigraphy in the anterior and posterior projections shows intensive inclusion of the preparation in the bone structures. Radiopharmaceuticals' distribution corresponds to the age norm. Since 2020, there have been two screenings in total. Comparing with the previous scanning dated February 4, 2020, the scintigraphic image of radiopharmaceutical distribution has relatively positive dynamics: the decrease of the radiopharmaceutical inclusion and foci sizes in the skull bones (projection of the left parietal bone), scapulae (total lesion of the right scapula), sternum, some ribs of the thorax (total lesion of 2 left ribs), vertebrae (the largest focus in the projection of L3 vertebra), and in pelvic bones. Radiopharmaceutical accumulation in the upper third of the right femur is at the same level. No new foci were reliably detected. Residual radioactivity in the kidneys and urinary tract corresponds to the time of the scanning. There is no atypical fixation of the medicine in parenchymal organs or soft tissues. MSCT of chest organs dated July 23, 2020.
Conclusion: Multiple mts in the skeletal bones of the osteoblastic type. Chronic deforming bronchitis. Basal pneumosclerosis. Quantitative lymphadenopathy of paratracheal lymph nodes. MSCT of abdominal organs and the small pelvis with IV contrast — ultravist 370-80.0 of July 23, 2020.
Conclusion: Prostate Cr, in the process of hormone therapy. Multiple mts in the skeletal bones of osteoblastic type. Diffuse liver changes, fatty hepatosis. Nodular hyperplasia of the left adrenal gland. Simple parapelvic cysts of the left kidney. Atherosclerosis of the aorta, iliac arteries. External iliac lymph node size was reduced compared to the MSCT of the small pelvis of February 25, 2020. MSCT of abdominal organs and small pelvis with IV contrast dated March 29, 2021.
Conclusion: Prostate Cr during hormone therapy. Multiple mts in bones on the skeleton of osteoblastic type. Cyst in the roof on the right acetabulum. Diffuse changes of liver, fatty hepatosis 1 stage. Nodular hyperplasia of the left adrenal gland. Simple parapelvical cysts of the left kidney. Atherosclerosis of the aorta, iliac arteries. Comparing with the description of MSCT of the abdominal organs and small pelvis dated July 23, 2020: without negative dynamics, there is a slight decrease in the size of the prostate gland. MSCT of thoracic organs with IV contrast dated March 29, 2021.
Conclusion: Multiple mts in the skeletal bones of osteoblastic type. Chronic deforming bronchitis. Bilateral basal pneumosclerosis. Atherosclerosis of the aorta. Compared with the screening dated July 23, 2020, without negative dynamics. Whole-body osteoscintigraphy dated March 25, 2021. Effective dosage: 3,1 mSv. Scintigraphy of the whole body in the anterior and posterior projections shows intensive inclusion of the drug in the bone structures. Radiopharmaceuticals' distribution corresponds to the age norm. Since 2020, there have been two screenings in total. Comparing with the previous scanning dated July 21, 2020, the scintigraphic image of the radiopharmaceutical distribution has relatively positive dynamics: the inclusion of medicine in previously revealed centres decreased. No new foci were reliably detected. Spinal curvature in the thoracic and lumbosacral regions. Residual radioactivity in the kidneys and the urinary tract corresponds to the time of the scanning. There is no atypical fixation of the medicine in parenchymal organs or soft tissues.
Started the next course of hormone therapy: (enzalutamide) + gozerelin + PDT.
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