PET Tumor Board: Case #5
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 69-year-old male with a history of multiple BPH treatments presenting with Gleason Grade 2 prostate cancer. 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 reviewing the patient’s treatment history, Dr. Crawford informs the panel that the patient initially presented with a PSA of 4.55 ng/ml, his 12 core biopsies were negative after 6 months of treatment, and he was placed on active surveillance post-biopsies. However, the patient returned one year after initial presentation with a PSA of 8.5 ng/ml. Dr. Crawford asks the panel to weigh in on next steps.
Dr. Petrylak recommends pursuing active surveillance based on the patient’s 2.1% Decipher score and the patient’s preference of preserving his quality of life. Dr. Koo suggests using an mpMRI to resolve the discordance between the PSA level and the negative biopsies.
Dr. Crawford shows the results from the patient’s POSLUMA scan which showed focal uptake in the right base of the prostate. Dr. Koo acknowledges that the scan results are promising, but he reminds the panel to be cautious about the sensitivity of PSMA PET before definitive therapy.
Dr. Crawford reveals that the patient had an mpMRI and 12 core biopsies in addition to the POSLUMA scan, all of which confirmed the presence of prostate cancer in the right base. The panel recommends focal therapy as a next step, and discusses the available options for focal therapy.
This is the fifth 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. For the fourth installment, click here.
