Remission of progressive metastatic castration-resistant prostate cancer during abiraterone therapy following unilateral adrenalectomy for a functioning adrenal adenoma. Issue 10 (5th October 2022)

• Record Type: Journal Article
• Authors: Seale, Katelyn Nazaneen; Labriola, Matthew K; Jiang, Xiaoyin "Sara"; Armstrong, Andrew
• Is Part Of: BMJ case reports. Volume 15:Issue 10(2022)
• Publication Date: 2022-10-05
• Subjects: Prostate -- Urological cancer -- Prostate Cancer; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2022-251036
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Despite advances and introduction of new therapies in the last decade, metastatic castration-resistant prostate cancer (mCRPC) has a poor prognosis. The development of androgen axis-targeted therapies such as abiraterone acetate, enzalutamide and darolutamide can prolong survival in mCPRC; however, resistance remains a barrier to prolonged response, necessitating exploration into resistance mechanisms and locoregional therapies. Here, we describe a patient with mCRPC that was progressing on abiraterone acetate. He was also found to have primary hyperaldosteronism from a functional adrenal adenoma, and thus he had a partial adrenalectomy to remove this tumour. Pathology confirmed an aldosterone-producing adrenal adenoma. After his adrenalectomy, he had a sharp decline in both his PSA (prostate specific antigen) and testosterone levels, and he enjoyed a year-long period of remission after his adrenalectomy. We propose several explanations for his response, the most likely being that his adenoma was producing both aldosterone and androgens. This is a unique case of mCRPC responding to partial adrenalectomy from a functional adrenal adenoma, and it raises insights that warrant further investigation into underlying mechanisms of resistance to androgen-targeted therapies.