E. David Crawford, MD; Wayne G. Brisbane, MD; Phillip J. Koo, MD; and Daniel P. Petrylak, MD, presented “PET Tumor Board Case 5: Gleason Grade 2 PCa After Multiple Treatments for BPH” for the Grand Rounds in Urology audience in July 2024.
How to cite: Crawford, E. David, MD, Brisbane, Wayne G., MD, Koo, Phillip J., MD, and Petrylak, Daniel P., MD. “PET Tumor Board Case 5: Gleason Grade 2 PCa After Multiple Treatments for BPH.” July 2024. Accessed Dec 2024. https://grandroundsinurology.com/pet-tumor-board-5/
PET Tumor Board Case 5: Gleason Grade 2 PCa After Multiple Treatments for BPH – Summary
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 it.
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.
ABOUT THE AUTHOR
Researcher-physician E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, 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.
Wayne G. Brisbane, MD, is an assistant professor of urology. Dr. Brisbane received his medical degree from Loma Linda University School of Medicine. He completed a General Surgery internship and Urology residency at the University of Washington. He completed his Urologic Oncology fellowship at UCLA, focusing on prostate cancer.
Phillip J. Koo, MD, is the Chief of Diagnostic Imaging at the Banner MD Anderson Cancer Center in Phoenix, Arizona. Prior to this, he was Chief of Nuclear Medicine and Associate Professor of Radiology at the University of Colorado School of Medicine in Aurora, Colorado. He completed his fellowship at the Harvard Medical School Joint Program in Nuclear Medicine in Boston, Massachusetts. Dr. Koo is a diplomate of both the American Board of Radiology (ABR) and American Board of Nuclear Medicine(ABNM).
Daniel P. Petrylak, MD, leads the genitourinary cancers medical oncology team at Smilow Cancer Hospital as director of the genitourinary cancer research group, professor, and co-director of the Cancer Signaling Network program. Dr. Petrylak joined Yale from Herbert Irving Cancer Center at Columbia University Medical Center with New York-Presbyterian Hospital, where he served as Professor of Medicine (Medical Oncology) and Urology and began his appointment in September of 2012. After serving for more than 20 years as the advanced bladder chair for SWOG, Dr. Petrylak is now the Vice Chair of the Genitourinary Committee.
