E. David Crawford, MD, presented “PET Tumor Board Case 5: A Case of a 77-year-old Prostate Cancer Patient with Ulcerative Colitis and Uncertain PET Findings” on July 15, 2025.

How to cite: Crawford, E. David. PET Tumor Board Case 5: A Case of a 77-year-old Prostate Cancer Patient with Ulcerative Colitis and Uncertain PET Findings. July 15, 2025. Accessed Nov 2025. https://grandroundsinurology.com/pet-tumor-board-case-5/

PET Tumor Board Case 5: A Case of a 77-year-old Prostate Cancer Patient with Ulcerative Colitis and Uncertain PET Findings – Summary

Why Watch: This tumor board case highlights prostate-specific membrane antigen (PSMA) positron emission tomography (PET) in prostate cancer, especially when false positives mimic nodal disease. The discussion illustrates how multidisciplinary collaboration can prevent overtreatment.

In this multidisciplinary prostate cancer tumor board, E. David Crawford, MD, Editor in Chief of Grand Rounds in Urology and Professor of Urology, University of California, San Diego, California, presents a case of a 77-year-old man with high-risk prostate cancer (PSA 4.2 ng/mL, Gleason score (4+4=8)). The patient also had ulcerative colitis, complicating treatment planning. Discussion participants include:

  • Wayne G. Brisbane, MD, Assistant Professor of Urology, University of California, Los Angeles, California
  • Sean P. Collins, MD, PhD, Radiation Oncologist, University of South Florida, Tampa, Florida
  • Sherief H. Gamie, MD, Chief & Director, Molecular Imaging and Theranostics, Professor of Clinical Radiology, UC San Diego Health
  • Andrew W. Hahn, MD, Assistant Professor, The University of Texas MD Anderson Cancer Center, Houston, Texas
  • Daniel P. Petrylak, MD, Professor of Medicine (Medical Oncology) and of Urology, Yale School of Medicine, New Haven, Connecticut

Prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging suggested a suspicious pelvic lymph node, initially interpreted as nodal metastasis. The panel considered androgen deprivation therapy (ADT), radiation to the prostate and pelvis, and potential intensification with an androgen receptor pathway inhibitor (ARPI) for 18–24 months. However, concerns were raised about added morbidity in an older patient with significant comorbidities.

Upon further review, a radiologist identified that the uptake corresponded to ureteral activity rather than nodal disease. A confirmatory CT urogram ruled out metastasis. Ultimately, the patient underwent stereotactic body radiation therapy (SBRT) to the prostate with ADT. He tolerated treatment well, with minimal added bowel toxicity, and achieved favorable early outcomes.

Panel members emphasized several key points:

  • False positives on PSMA PET can mimic nodal or metastatic disease, requiring correlation with MRI or CT.
  • Histologic confirmation, when feasible, is critical for ambiguous PSMA PET findings.
  • Multidisciplinary review prevents misinterpretation and unnecessary overtreatment.
  • Patient comorbidities (e.g., ulcerative colitis) must guide treatment selection, balancing efficacy and toxicity.

This case reinforces the need for cautious interpretation of PSMA PET and the value of integrating conventional imaging and expert multidisciplinary input.