His baseline PSA level was 8 ng/mL. All six biopsy cores contained 90% Gleason scores of 3+4 = 7 adenocarcinoma, and peri-neural invasion was observed. The patient’s clinical stage was T1c. He elected therapy with intermittent androgen deprivation (IAD) with flutamide, leuprolide, and finasteride. In 2007, after the third cycle of IAD, his PSA level slowly increased into the 3 ng/mL range and his serum testosterone remained < 20 ng/dl. Sequential anti-androgen withdrawal, ketoconazole, diethylstilbestrol, estramustine, and transdermal ?-estradiol, along with a trial of low-dose oral cyclophosphamide and capecitabine, all while he was being treated with leuprolide maintenance therapy, were either transiently effective or unsuccessful.
The patient was restaged, with a bone scan and computed tomography yielding only evidence of biochemical PSA relapse. He then received docetaxel 30 mg/m 2 for three of every four weeks while his leuprolide treatment was continued. His PSA level continued to rise exponentially for 18 weeks, thus we assumed docetaxel resistance. The patient revealed that he was ingesting a supplement of 10 daily dose units of Intrinsi Btwelve/folate (Metagenics, San Clemente, CA, USA. Více
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