Treatment Options
In view of the advanced stage of the disease and evidence of distant metastasis, the primary treatment modality for this patient was systemic therapy. The pattern of metastatic disease, that is, extensive local involvement and likely extension into the bladder, as well as the virtual replacement of a vertebral body with disease in close anatomic proximity to the nerve root, suggested that in addition to the standard systemic approach, local palliative measures should be considered. Importantly, the constellation of signs and symptoms of this patient’s disease underscored the critical need to select a systemic treatment that produced a rapid decline of serum testosterone and consequently allowed prompt control of the disease. He was, therefore, treated with abarelix, 12 a gonadotropin-releasing hormone (GnRH) antagonist.