What are the next steps for a patient presenting with dysphasia and unintended weight loss, with a computed tomography (CT) scan of the chest/abdomen/pelvis showing multiple sclerotic foci consistent with osseous metastatic disease, multiple pulmonary nodules, mediastinal (medial) hilar lymphadenopathy, and an enlarged prostate gland with macrocalcifications?

From the Guidelines

The patient should undergo a comprehensive evaluation to confirm the diagnosis of metastatic prostate cancer, including a prostate-specific antigen (PSA) test, prostate biopsy, and bone scan, and if confirmed, should be initiated on androgen deprivation therapy (ADT) with a GnRH agonist like leuprolide, and considered for additional systemic therapy such as abiraterone acetate or enzalutamide, while also addressing pain management, dysphasia, and nutritional support. Given the presentation of dysphasia, weight loss, and imaging findings of widespread sclerotic bone lesions, pulmonary nodules, and an enlarged prostate with calcifications, metastatic prostate cancer is the most likely diagnosis 1. A multidisciplinary approach is essential, involving urology, oncology, and possibly radiation oncology. The patient's symptoms and imaging findings are consistent with metastatic disease, and the presence of sclerotic bone lesions and pulmonary nodules suggests a high risk of morbidity and mortality if left untreated 1.

Diagnostic Evaluation

• PSA test to confirm elevated levels
• Prostate biopsy to confirm the diagnosis of prostate cancer
• Bone scan to evaluate the extent of bone metastases
• CT scan of the chest, abdomen, and pelvis to evaluate for visceral metastases
• Consideration of PET CT scan for further evaluation of metastatic disease

Treatment Approach

• Initiation of ADT with a GnRH agonist like leuprolide 7.5 mg monthly injections, often with an anti-androgen like bicalutamide 50 mg daily for the first 2-4 weeks to prevent testosterone flare
• Consideration of additional systemic therapy such as abiraterone acetate 1000 mg daily with prednisone 5 mg daily, or enzalutamide 160 mg daily for metastatic disease
• Pain management, potentially including palliative radiation for painful bone metastases
• Evaluation of dysphasia by a speech pathologist and possibly a gastroenterologist to determine if it's related to metastatic disease affecting the esophagus or neurological function
• Nutritional support, including consultation with a dietitian, to address weight loss and optimize nutritional status 1.

Multidisciplinary Approach

• Involvement of urology, oncology, and possibly radiation oncology to develop a comprehensive treatment plan
• Consideration of the patient's overall health, including comorbidities and performance status, in determining the best course of treatment 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Next Steps for Patient with Dysphasia and Unintended Weight Loss

The patient's presentation with dysphasia and unintended weight loss, along with the CT scan findings of multiple sclerotic foci consistent with osseous metastatic disease, multiple pulmonary nodules, mediastinal (medial) hilar lymphadenopathy, and an enlarged prostate gland with macrocalcifications, suggests a possible diagnosis of metastatic prostate cancer 2, 3, 4.

Diagnostic Considerations

• The patient's symptoms and imaging findings are consistent with advanced prostate cancer, which often presents with metastatic disease to the bones, lungs, and lymph nodes 4.
• The presence of an enlarged prostate gland with macrocalcifications on the CT scan is also suggestive of prostate cancer 5.
• Prostate-specific antigen (PSA) is a useful biomarker for detecting prostate cancer, and elevated PSA levels are often seen in patients with metastatic disease 2, 5.

Treatment Options

• The standard initial systemic therapy for advanced prostate cancer is androgen-deprivation therapy (ADT), which can help to reduce PSA levels and slow disease progression 2.
• However, patients with metastatic prostate cancer often progress to castration-resistant prostate cancer (CRPC), which has a high mortality rate 2.
• Nursing professionals play a vital role in symptom recognition and reporting, identification of disease progression, patient education, and implementation of individualized treatment strategies 4.

Further Evaluation and Management

• A full staging workup, including a prostate biopsy, may be necessary to confirm the diagnosis and assess the extent of disease 3.
• The patient's symptoms, such as dysphasia and unintended weight loss, should be managed aggressively to improve quality of life 4.
• Regular monitoring of PSA levels and imaging studies can help to assess response to treatment and detect disease progression early 2, 4.