Disclaimer: This thread is for educational purposes only and is not medical advice. Always consult hematology and medical oncology or appropriate specialists for patient-specific decisions.

1/ Let’s start with a case 72M with metastatic prostate cancer, dx 1y ago, on leuprolide+abiraterone+prednisone w/ regular follow-ups in clinic. In the ED for pneumonia, missed all his home meds. You admit him to medicine & he’s now stable, labs normal. What’s your next move?

2/ Prostate cancer is one of the most common cancer in men. Odds are, you’ll admit a patient with it maybe for the cancer itself, maybe for something totally unrelated. Either way, you’ll need a game plan. Let’s talk about what to do on the wards.

3/ Prostate Cancer 101 So what is prostate cancer, and why is it so different? 🧐 Is this an inherited disease? – Most cases are sporadic (pop up without a clear inherited mutation). But family history does raise risk, and mutations like BRCA2 or DNA repair genes can tip the

4/ What’s the deal with PSA? Why do we talk about it so much? 🧐 – PSA = Prostate-Specific Antigen. It’s a protein made by prostate cells (both normal and cancerous) that leaks into the blood. 🩸 – In healthy men, PSA is low. In prostate cancer, it often climbs; so a high PSA

5/ How does prostate cancer actually show up in real life? Three common scenarios: 1️⃣ Completely silent. Many men feel totally fine. A routine screening PSA test comes back high → triggers more workup (MRI of the prostate → biopsy) → and that’s how the cancer is caught. 2️⃣

6/ 📝 One last “boring” post before we move into the practical side of internal medicine… 💭 People often ask: “If MRIs are so good at spotting tumors, why do we still stick needles into the prostate for a 12-core biopsy? And why don’t we do this in other cancers?”🤔 Here’s

7/ Alright, enough theory; let’s move to real life on the wards. This thread will zoom in on two scenarios you’re guaranteed to see on the inpatient side: 1️⃣ A patient presenting with newly diagnosed metastatic prostate cancer. 2️⃣ A patient with known prostate cancer, already

8/ Scenario 1: De novo metastatic prostate cancer When prostate cancer first shows up in the hospital, it’s usually not because someone “felt a lump.” It’s the complications that bring them in: – 🦴 Spinal cord compression → severe back pain, weakness, numbness, sometimes

9/ So what happens next when someone shows up with these presentations? 🏥 The workup usually starts as follows: – CBC (blood counts) – CMP (metabolic panel) + LFTs (part of CMP) – Coags (clotting studies) But the real star here is imaging. 👉 A CT chest/abdomen/pelvis +\-

10/ Where do you actually biopsy when you suspect metastatic prostate cancer? 🔬 👉 General oncology rule: go for the easiest, safest, distant and most informative site. – Soft tissue (like lymph nodes, liver, lung lesions) is ideal → better yield l, will prove metastasis AND

11/ 🧾 The biopsy comes back: adenocarcinoma of the prostate (the classic histology). PSA is sky-high. Now it’s official: prostate cancer. So what do we actually do for treatment? 👉 The backbone of therapy in metastatic prostate cancer is cutting off testosterone: the fuel

12/ ⚙️ Step 1: Androgen Deprivation Therapy (ADT) Androgen Deprivation Therapy (ADT) This is the backbone of treatment for metastatic prostate cancer. The idea is simple: starve the cancer of testosterone. – Normally, the hypothalamus releases GnRH → tells the pituitary to

13/ 💭 “So wait… what’s the deal with bicalutamide? I’ve seen it used in these patients with a new diagnosis” 👉 Here’s the story: – Bicalutamide (Casodex) is one of the earliest androgen receptor blockers. – Think of it as a “plug” that sits on the androgen receptor so

14/ 💭 “So what does this all mean in real life when a patient rolls into the hospital with new metastatic prostate cancer?” 🤔 👉 Here’s the workflow you’ll usually see: – Inpatient: oncology often starts bicalutamide (Casodex) right away. This blocks the receptor and protects

14’/ ⚠️ There’s one rare but critical scenario you need to know. A patient with prostate cancer on treatment gets admitted. Suddenly there’s concern for progression either new symptoms (bone pain, weight loss, neuro changes) or clear progression on imaging. Naturally, you send a

15/ Done with scenario 1. Let’s talk Scenario 2: Patients with known stable prostate cancer gets admitted for something unrelated (e.g. Pneumonia, UTI, CHF…) 💭 “What do I do with abiraterone + prednisone when they get admitted?” 🤔 So what do you do with a patient on

16/ What to do with enzalutamide, apalutamide, or darolutamide when your patient gets admitted? These are the -lutamides, androgen receptor pathway inhibitors (ARPIs). 👉 General rule – If the patient is stable and can take pills → keep going. – If they’re critically ill, NPO,

17/💭 “So what if my patient is on outpatient ADT? Should I worry about that while they’re admitted?” Not really. ADT (GnRH agonists like leuprolide or antagonists like degarelix/relugolix) are depot injections usually given every 1, 3, or 6 months. – If they’re not due during

18/ 💭 “Should I send a PSA while the patient is admitted?” 👉 It depends. – If your patient with know prostate cancer has been lost to follow-up and hasn’t had a PSA checked in >6 months in clinic, and you’re worried about progression as the cause of admission(new bone pain,

19/ 💭 “What if my patient had prostate cancer years ago, got definitive treatment (surgery or radiation), and has been in remission, should I check a PSA while he’s admitted for something unrelated?” 🤔 👉 Usually no. – If they’re actively followed in clinic and up to date with

20/ I’m pretty sure you’ve heard oncologists throw around the terms castrate-sensitive and castrate-resistant prostate cancer. Let’s demystify this and cut through the confusion. 👉 Remember when we said testosterone fuels prostate cancer? When we use the word castrate, we mean

📝 To wrap this up: Prostate cancer is, for the most part, a slow-growing disease. That’s why on the wards you’ll meet so many patients with a history of prostate cancer who were treated years even decades ago and are still doing well. I’ve seen patients treated back in the

And that’s a wrap, folks! That’s it for today. If you’ve been following along, I’m hoping to grow this series into a go-to resource for hospital-based docs navigating hematology oncology cases. Open to suggestions or feedback. If you like this format, like, repost, and share

And if you missed my episode from last Friday on Chronic Myeloid Leukemia (CML), link below 👇🏻