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Multi-gene mutation metastatic castrate-resistant prostate cancer
  1. Joshua Christy1,
  2. Emad Kandah1,
  3. Kavitha Kesari2 and
  4. Trevor Singh3
  1. 1Internal Medicine, McLaren Regional Medical Center, Flint, Michigan, USA
  2. 2Internal Medicine, McLaren Health Care Corp, FLINT, Michigan, USA
  3. 3McLaren Regional Medical Center Flint, Karmanos Cancer Institute, Flint, Michigan, USA
  1. Correspondence to Dr Joshua Christy; joshua.christy{at}


Gene panel sequencing of metastatic castrate-resistant prostate cancer (mCRPC) can assist in identifying appropriate targeted therapies. Although some studies have reported single DNA mutations, this is the first case of mCRPC with five different DNA mutations based on gene panel analysis. The patient, a 75-year-old man, initially presented with haematuria. Laboratory investigation revealed elevated prostate-specific antigen levels, and CT showed an enlarged prostate gland with metastatic lymph nodes. A 12-core biopsy revealed adenocarcinoma of the prostate. Gene panel sequencing demonstrated five different DNA mutations associated with sensitivities to olaparib and pembrolizumab. Treatment failure after hormonal therapy with leuprorelin and bicalutamide resulted in the initiation of chemotherapy with docetaxel. Over the past decade, development of genome sequencing analysis may guide us with more precise targeted therapy specific to mCRPC early on, especially with poly (ADP-ribose) polymerase inhibitors may show survival benefits.

  • Prostate Cancer
  • Prostate
  • Oncology
  • Urology

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  • Contributors All authors conceived the idea of writing the case report, performed the literature search, discussed the literature findings and contributed to the final manuscript. JC and EK wrote the manuscript with support from KK and TS. KK supervised the project. All authors reviewed, discussed and provided critical feedback to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.