Stories of patients

(personal information was changed)
At the oncological monitoring since 2019
Treating doctor Vladimir V. .
stage IV prostate cancer T4N1M1 with bone metastasis

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 27.12.2019: acinar cribrotic 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:

  • Skull bones (projection of the left pariental bone),
  • Scapula (total damage of the right scapula),
  • Sternum,
  • Separate ribs of the chest (total damage of 2 left ribs),
  • Vertebrae (the largest damage in the projection of L3 vertebra),
  • Pelvic bones,
  • Upper third of the right femur.

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 organs of the lesser pelvis with i/v contrast (iomeron 400 mg-5,0 per os, iomeron 400 mg – 80 ml) dated 25.02.2020.

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 daily before the development of castratresistance + goserelin 10,8 mg once a day for 3 months) + therapy with bisphosphonates – zoledronic acid 4 mg once a day for 28 days. The patient does not get medications within AMS and RMS.

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Stages of treatment:

Medical commission took place. As the result, there was taken a decision to choose the treatment described above: enzalutamide 160 mg daily before the development of castratresistance + goserelin 10,8 mg once a day for 3 months + therapy with bisphosphonates – zoledronic acid 4 mg once a day for 28 days.

Whole body osteoscintigraphy dated 21.07.2020. Intensive inclusion of the medicine into bone structures is seen in the front and rear projections in the scintigrams of the whole body. Radiopharfaceutical distribution corresponds to the age norm. Two screenings total during the period of monitoring since 2020. Comparing with the previous scanning dated 04.02.2020 – scintigraphic image of radiopharfaceutical distribution has relatively positive dynamics: pathological accumulation of the radiopharfaceutical and foci sizes in skull bones (projection of the left pariental bone), scapulae (total damage of the right scapula), sternum, separate ribs of the chest (total damage of 2 left ribs), vertebrae (the largest damage in the projection of L3 vertebra), pelvic bones have decreased. radiopharfaceutical accumulation in the upper third of the right femur is at the same level. No new foci of inflammation were revealed. Residual radioactivity in kidneys and the urinary tract corresponds to the time of the scanning. Atypical fixation of the medicine in parenchymal organs and soft tissues is absent. MSCT of chest organs dated 23.07.2020.

Conclusion: Multiple mts in bones on the skeleton of osteoblastic type. Chronic deflating bronchitis. Basal pneumosclerosis. Quantitative lymphadenopathy of paratracheal lymph nodes. MSCT of abdominal organs, the lesser pelvis with i/v contrast-ultravist 370-80,0 dated 23.07.2020.

Conclusion: Prostate Cr during hormone therapy. Multiple mts in bones on the skeleton of osteoblastic type. Diffuse changes of liver, fatty hepatosis. 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 lesser pelvis dated 25.02.20: decrease of sizes of outer iliac lymph nodes is seen. MSCT of abdominal organs and the lesser pelvis with i/v contrast dated 29.03.2021.

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 abdominal organs and lesser pelvis dated 23.07. 2020: there is no negative dynamics, some decrease of the prostate size. MSCT of chest organs with i/v contrast dated 29.03.2021.

Conclusion: Multiple mts in bones on the skeleton of osteoblastic type. Chronic deflating bronchitis. Bilateral basal pneumosclerosis. Atherosclerosis of the aorta. Comparing with the screening dated 23.07.202: there is no negative dynamics. The whole body osteoscintigraphy dated 25.-3.2021. Effective dosage: 3,1 mSv. Intensive inclusion of the medicine into bone structures is seen in the front and rear projections in the scintigrams of the whole body. Radiopharfaceutical distribution corresponds to the age norm. Three screenings total during the period of monitoring since 2020. Comparing with the previous scanning dated 21.07.2020 – scintigraphic image of the radiopharfaceutical distribution has relatively positive dynamics: inclusion of medicine in previously revealed centres decreased. New foci were not revealed. Spinal curvature in the thoracic and lumbosacral regions. Residual radioactivity in kidneys and the urinary tract corresponds to the time of the scanning. Atypical fixation of the medicine in parenchymal organs and soft tissues is absent.

Started the next course of hormone therapy: (enzalutamide) + gozerelin + PDT.

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number of
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2. Blood chemistry: creatinine, urea, AST, ALT, protein total, bilirubin (valid for 14 days).
3. ECG with the interpretation (valid for 1 month).

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