Curious about the case challenges? Compare yourself with your peers, and challenge the RENALC-BLADDR-PROSCA faculty.
Wilma, 69 years old, still cooks traditional Dutch meals every Sunday, but she always ends dessert with ‘stroopwafels’ warmed over tea for her grandchildren. She says it is a small tradition that keeps everyone at the table a little longer.
She recently underwent cystoscopy for painless haematuria, revealing a papillary bladder tumour. Her past medical history includes stable coronary artery disease, hypertension and borderline diabetes. She quit smoking 25 years ago.
Assessment summary:
- Diagnostic TURBT, pathological review:
- At least pT2 urothelial carcinoma (UCa)
- Unifocal, no concomitant carcinoma in situ (CIS)
- Imaging: suggestive for cT3N0M0
- Ultrasound: no hydronephrosis
- CrCl: 66 ml/min
- No peripheral neuropathy
- No hearing impairment
- ECOG PS: 0
- Cardiac ejection fraction: 62%
The multidisciplinary tumour board assessed that the patient is a candidate for RC + PLND.
Regulatory approval and local restrictions aside, which option would you suggest for Ines?
(click on the option you would recommend & scroll down to compare your answer with Dr. Thomas Powles)
B. Neoadjuvant full dose gemcitabine + cisplatin (GC)
C. Neoadjuvant full dose GC + perioperative durvalumab
D. Neoadjuvant split dose GC + perioperative durvalumab
Hendrik, 72 years old, used to work as a canal guide. He preferred the quieter early morning tours, when the water was calm and the city felt like it belonged to him again for a short moment. Now, his son sometimes takes him along on his own boat for a tour through the canals.
Assessment summary:
Hendrik has a history of PCa:
- 8 years ago: RP + ePLND for high-risk PCa (pT3aN0M0), ISUP grade group 4, undetectable postoperative PSA
- 6 years ago: salvage EBRT to the prostate bed without ADT for rising PSA (0.24 ng/ml)
- 4 years ago: ADT + abiraterone/prednisone for low-volume mHSPC (PSA 0.7 ng/ml, 2 bone metastases on the spine)
- 1.5 years ago: docetaxel for oligoprogressive mCRPC (PSA: 9.8 ng/ml, testosterone: 12 ng/dl (0.42 nmol/l), 4 metastases on the spine, 1 on the pelvis, small pelvic LNs), ADT continued throughout treatment
Current situation:
- Medical history: controlled hyperlipidaemia (on statin therapy)
- ECOG PS: 0
- Symptoms: back pain (under control with NSAIDs) and mild fatigue
- Lab values: normal
- PSMA PET/CT: progression in bone only with multiple PSMA-avid bone metastases (4 on spine, 2 on pelvis, 1 on left rib), stable small pelvic LNs, no visceral metastases
Which genomic alteration would you prioritise testing for in this patient (not taking into account regulatory approval and local restrictions)?
(click on the option you would recommend & scroll down to compare your answer with Dr. Alice Bernard-Tessier)