How to cite: Morris, DS., Garmezy, B, Phillips, JG. “A Case of CRPC Using PSMA PET Imaging & a Case of Gleason 9, PSA of 200, and Slowly Rising PSA.” November 2025. Accessed Jan 2026. https://grandroundsinurology.com/a-case-of-crpc-using-psma-pet-imaging-a-case-of-gleason-9-psa-of-200-and-slowly-rising-psa/
In this Tumor Board, E. David Crawford, MD, Editor in Chief of Grand Rounds in Urology and Professor of Urology, University of California, San Diego, San Diego, California, introduces a multidisciplinary panel that discusses two complex cases of men with advanced prostate cancer. Panelists include David S. Morris, MD, FACS, Urology Associates, PC, Nashville, Tennessee, Benjamin Garmezy, MD, Sarah Cannon Research Institute, Nashville, Tennessee, and John G. Phillips, MD, MPH, Tennessee Oncology, Nashville, Tennessee.
The first case reviewed is an 81-year-old man with rising prostate-specific antigen (PSA) and prostate-specific membrane antigen (PSMA)-avid nodal metastases after androgen-deprivation therapy and abiraterone is reviewed. Dr. Morris presents the patient’s favorable performance status and lack of visceral disease. Dr. Garmezy discusses evidence supporting lutetium-177 PSMA (PluvictoⓇ) use before or after taxane therapy. Given the patient’s low-volume, nodal-only disease and absence of prior chemotherapy, the panel agrees that radioligand therapy is appropriate if uptake on PSMA PET exceeds SUV 10 and marrow reserve remains adequate. Dr. Phillips highlights the role of radiation therapy for local control or symptomatic nodes and recommends post-therapy PSMA imaging for response monitoring.
The second case features a younger patient with diffuse osseous metastases who has progressed after docetaxel and cabazitaxel. Laboratory results reveal mild anemia and preserved renal function. Based on genomic testing, the group evaluates whether to initiate lutetium-177 PSMA or consider a PARP inhibitor. Dr. Garmezy notes the benefit of assessing BRCA and ATM status to identify eligibility for olaparib or rucaparib. Dr. Morris emphasizes coordination between specialties for sequencing radium-223, taxane, and radioligand therapy to minimize hematologic toxicity. The panel agrees that, for this patient, radioligand therapy may be reasonable after prior chemotherapy.
This multidisciplinary panel emphasizes communication among urology, medical oncology, and radiation oncology to secure the best patient outcomes.
ABOUT THE AUTHOR
David S. Morris, MD, FACS, graduated summa cum laude from Vanderbilt University and earned his doctorate from Vanderbilt University School of Medicine in Nashville, Tennessee. Dr. Morris completed his residency training at the University of Michigan in Ann Arbor, Michigan, with a special research interest in genetics that predict the aggressiveness of prostate and bladder cancers. He authored and co-authored multiple scientific papers throughout his training and has presented research findings at regional and national meetings. He helps coordinate the genitourinary cancers program at Urology Associates’ Advanced Therapeutics Center as well as the Urology Associates Clinical Trials Program.
Benjamin Garmezy, MD, is the Associate Director of Genitourinary Research and Executive Co-Chair of the Genitourinary Cancer Research Executive Committee at SCRI Oncology Partners. He specializes in genitourinary oncology research, overseeing clinical trials for prostate, kidney, testicular, and bladder cancers while offering a variety of treatment options to patients, including immunotherapy, chemotherapy, targeted therapy, and precision oncology.
John G. Phillips, MD, MPH, is a board-certified radiation oncologist at Tennessee Oncology in Nashville, Tennessee, and one of the founders of Health Tech Startup. He previously worked as a radiation oncologist and the medical director of Radiation Oncology Pathways at the Dana-Farber Cancer Institute in Boston, Massachusetts. His clinical specialties include internal and external beam radiation therapy, brachytherapy, and systemic radiation therapy.
