How to cite: Morris, DS., Garmezy, B, Phillips, JG. “A PCa Case of PSA Recurrence After Retropubic RP, XRT & a Case of Diffusely mPCa Developing Castration Resistance.” November 2025. Accessed Apr 2026. https://grandroundsinurology.com/a-pca-case-of-psa-recurrence-after-retropubic-rp-xrt-a-case-of-diffusely-mpca-developing-castration-resistance/
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.
In the first case, a 78-year-old man with biochemical recurrence after prostatectomy and salvage radiation presents with multifocal bone metastases. He has received androgen deprivation therapy, enzalutamide, and Radium-223, and now demonstrates PSMA-avid skeletal disease with spinal cord compression. Dr. Morris presents the imaging and symptom progression. Dr. Garmezy discusses the hematologic risk of administering lutetium-177 PSMA following Radium-223. Dr. Phillips emphasizes the importance of local radiation for palliation before systemic therapy. The group agrees that PluvictoⓇ can be considered after Radium-223 if marrow function remains sufficient and imaging confirms strong PSMA uptake (SUV >10).
The second case involves an 83-year-old man with rapid disease progression six months after docetaxel, presenting with nodal and cervical involvement. His PSMA PET shows SUVmax greater than 20. Dr. Garmezy outlines evidence supporting Pluvicto in taxane-pretreated mCRPC. Dr. Morris raises the alternative of cabazitaxel, while Dr. Phillips notes that nodal disease responds well to radioligand therapy when uptake is high. The panel discusses treatment, Gleason score, and PSMA uptake intensity as factors guiding therapy. Consensus is that patients with strong PSMA expression and preserved marrow reserve are appropriate candidates for lutetium-177 PSMA even after multiple prior lines. At the same time, chemotherapy remains an option for rapidly progressing disease.
The conversation emphasizes coordination between urology, medical oncology, and radiation oncology when deciding treatment for heavily pretreated prostate cancer.
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.
