The Patient with Postprandial Right Upper Quadrant Abdominal Pain

The Case

You are asked to evaluate a 64-year-old man with castrate-resistant prostate cancer who has failed treatment with docetaxel plus prednisone. His latest MRI demonstrates new pelvic lymphadenopathy with a PSA of 11.2 ng/mL, which has increased from 4.1 ng/mL after his docetaxel/prednisone therapy was completed 1 year ago. He has no documented bone metastases. He has type-2 diabetes mellitus, taking glipizide 10 mg twice daily, metformin 1000 mg twice daily, and liraglutide 1.2 mg twice daily and was hospitalized with severe hyperglycemia following prednisone. He would prefer a prednisone-free treatment option.