E. David Crawford, MD; Wayne G. Brisbane, MD; Phillip J. Koo, MD; and Daniel P. Petrylak, MD, presented “PET Tumor Board Case 4: Rapid Rise in PSA” for the Grand Rounds in Urology audience in June 2024.
How to cite: Crawford, E. David, MD, Brisbane, Wayne G., MD, Koo, Phillip J., MD, and Petrylak, Daniel P., MD. “PET Tumor Board Case 4: Rapid Rise in PSA.” June 2024. Accessed Dec 2024. https://grandroundsinurology.com/pet-tumor-board-4/
PET Tumor Board Case 4: Rapid Rise in PSA – Summary
In this discussion, E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, leads a discussion of the case study of a healthy 80-year-old male with a history of BPH presenting with a rapid rise of PSA from a PSA of 3-4 ng/ml to 9.7 ng/ml and increased urgency and perception of difficulty fully voiding. He presents this case study to a panel of experts comprised of:
- Wayne G. Brisbane, MD – Assistant Professor of Urology at the University of California, Los Angeles.
- Phillip J. Koo, MD – Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center.
- Daniel P. Petrylak, MD – Director of Genitourinary Oncology, Professor of Medicine and Urology, Co-Leader of Cancer Signaling Networks, and Co-Director of the Signal Transduction Program at Yale University Cancer Center.
After revealing that the patient had a PSA of 7.2 ng/ml after a 4-week course of Cipro, Dr. Crawford tells the panel that his recommendation was for the patient to undergo an mpMRI, and possible biopsies. This revealed that the patient had a 65g prostate with a PI-RADS 5 lesion, and several suspicious pelvic lymph nodes. After a 12-core biopsy, it was found that each core had a Gleason Score of 4 or 5.
Dr. Crawford then asks the panel to weigh in on the next steps for imaging for the patient. Dr. Petrylak and Dr. Koo both recommend PSMA PET scanning over bone scans as the appropriate next step.
Dr. Crawford presents the results of the patient’s PSMA PET scan, which revealed extensive disease, to the panel. Dr. Petrylak recommends ADT, and debates the use of doublet or triplet therapy for the patient. Dr. Brisbane points out that the patient’s PSA level does not necessarily reflect the burden of disease, and Dr. Petrylak agrees that, while Dr Brisbane raises an important point, there is currently no data to recommend additional histologic studies.
Dr. Crawford informs the panel that the patient responded well after therapy, and he asks them to provide their thoughts on how to follow the patient. The panel discusses whether there is a need for additional imaging.
Finally, the panel discusses the need to treat the primary. The panel debates the value of a PSMA PET scan to evaluate the primary in this patient. The panel is ambivalent, citing the lack of long-term data supporting its use in the primary.
This is the fourth in a series of discussions on PSMA PET supported by Blue Earth Diagnostics. For the first installment, click here. For the second installment, click here. For the third installment, click here.
Wayne G. Brisbane, MD
University of California, Los Angeles
Los Angeles, California
Phillip J. Koo, MD
Banner MD Anderson Cancer Center
Phoenix, Arizona
Daniel P. Petrylak, MD
Yale University Cancer Center
New Haven, Connecticut
ABOUT THE AUTHOR
Researcher-physician E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States.
Daniel P. Petrylak, MD, leads the genitourinary cancers medical oncology team at Smilow Cancer Hospital as director of the genitourinary cancer research group, professor, and co-director of the Cancer Signaling Network program. Dr. Petrylak joined Yale from Herbert Irving Cancer Center at Columbia University Medical Center with New York-Presbyterian Hospital, where he served as Professor of Medicine (Medical Oncology) and Urology and began his appointment in September of 2012. After serving for more than 20 years as the advanced bladder chair for SWOG, Dr. Petrylak is now the Vice Chair of the Genitourinary Committee.
Phillip J. Koo, MD, is the Chief of Diagnostic Imaging at the Banner MD Anderson Cancer Center in Phoenix, Arizona. Prior to this, he was Chief of Nuclear Medicine and Associate Professor of Radiology at the University of Colorado School of Medicine in Aurora, Colorado. He completed his fellowship at the Harvard Medical School Joint Program in Nuclear Medicine in Boston, Massachusetts. Dr. Koo is a diplomate of both the American Board of Radiology (ABR) and American Board of Nuclear Medicine(ABNM).
Wayne G. Brisbane, MD, is an assistant professor of urology. Dr. Brisbane received his medical degree from Loma Linda University School of Medicine. He completed a General Surgery internship and Urology residency at the University of Washington. He completed his Urologic Oncology fellowship at UCLA, focusing on prostate cancer.
