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: Brisbane, Wayne G., MD, Crawford, E. David. MD, Koo, Phillip J., MD, and Petrylak, Daniel P., MD. “PET Tumor Board Case 4: Rapid Rise in PSA.” June 2024. Accessed Jul 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, Professor of Urology and Jack A. Vickers Director of Prostate Research 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 in New Haven, Connecticut.

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.

Steven Kaplan, BPH

Wayne G. Brisbane, MD
University of California, Los Angeles
Los Angeles, California

 

Steven Kaplan, BPH

Phillip J. Koo, MD
Banner MD Anderson Cancer Center
Phoenix, Arizona

 

Daniel P. Petrylak, MD

Daniel P. Petrylak, MD
Yale University Cancer Center
New Haven, Connecticut

 

ABOUT THE AUTHOR

Researcher-physician E. David Crawford, MD, 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.

He is currently a Professor of Urology and Jack A. Vickers Director of Prostate Research at the University of California, San Diego. Dr. Crawford received his medical degree from the University of Cincinnati and his postgraduate training included an internship and residency in urology at the Good Samaritan Hospital in Cincinnati. He subsequently completed a genitourinary cancer fellowship at the University of California Medical Center in Los Angeles.

Dr. Crawford is an internationally recognized expert in benign prostate hypertrophy, urologic cancers, and in particular, prostate cancer. He has conducted research in the treatment of advanced bladder cancer, metastatic adenocarcinoma of the prostate, hormone-refractory prostate cancer, and other areas of urological infections and malignancies. He has authored or coauthored over 810 scientific articles, has published seven textbooks, authored over 60 book chapters, and provided more than 2,200 educational talks for patients and physicians.

In an effort to raise public awareness about prostate health, Crawford in 1989 founded the Prostate Conditions Education Council (PCEC). The non-profit organization is comprised of a consortium of leading physicians, health educators, scientists, and men's health advocates. PCEC's advocacy for free or low-cost prostate screening has affected the lives of millions of American men. He currently chairs the PCEC.

Crawford is an active member of many national and international organizations, including the American Society of Clinical Oncology, the American Urological Association (AUA), and the American Association for the Advancement of Science. Within the AUA, he has been a member of the Committee to Study Urologic Research Funding and the prostate cancer clinical trials subcommittee. Crawford served on the board of governors, the scientific advisory board of the Southwest Oncology Group, and was chairman of the Genitourinary Cancer Committee for 27 years. This group is the largest clinical trials group in the world.

Crawford's involvement in the national prostate cancer arena has been widely recognized. He has received many honors and awards, including the CAP Cure Annual Award for Scientific Presentation in 1999 In 1997, he was presented with a 'Freddie Award" at the AMA International Health and Medical Film Competition for the program, ITV: The Cutting Edge Medical Report (Prostate Cancer: Understanding, Diagnosing, and Defeating), which Crawford hosted with special guest, retired General Norman Schwarzkopf.

Crawford again won a prestigious 'Freddie Award" 5 years ago... He is a member of Best Doctors of America and was named Healthcare Provider of the Year in the Denver Metro area by the Denver Business Journal.

He has been recognized as one of the Best Doctors of America for the past two decades and is recognized as one of the top 20 urologists in the country, for men, by Men’s Health Magazine. In 2018 he received the honor of being named the Distinguished Alumnus of the Year from the University of Cincinnati School of Medicine. In May of 2019, he received the Presidential citation from the American Urological Association recognizing for his “tireless role in genitourinary cancer research that has benefited countless urologic cancer patients.” He accepted the position of Editor in Chief of Grand Rounds in Urology in June of 2019. In 2021, he was the recipient of the Merle Stringer, M.D. annual award for excellence in medicine by the Florida State Medical Association.