E. David Crawford, MD, presents “PET Tumor Board – Case 1: A Case of a 55-year-old Prostate Cancer Survivor with Rising PSA Five Years After Radical Prostatectomy.”

How to cite: Crawford, E. David. “PET Tumor Board – Case 1: A Case of a 55-year-old Prostate Cancer Survivor with Rising PSA Five Years After Radical Prostatectomy.” February 19, 2025. Accessed Jul 2025. https://grandroundsinurology.com/pet-tumor-board-case-1/

PET Tumor Board – Case 1: A Case of a 55-year-old Prostate Cancer Survivor with Rising PSA Five Years After Radical Prostatectomy – Summary

In this multidisciplinary PET Tumor Board discussion, E. David Crawford, MD, Editor in Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, presents a real-world case from his clinical practice, extracting meaningful, applicable learning points. Discussion participants include:

  • Wayne G. Brisbane, MD, Assistant Professor of Urology, University of California, Los Angeles, Los Angeles, California
  • Sean P. Collins, MD, PhD, Radiation Oncologist, University of South Florida, Tampa, Florida
  • Sherief H. Gamie, MD, Nuclear Medicine Physician, University of California, San Diego, San Diego, California
  • Daniel P. Petrylak, MD, Professor of Medicine (Medical Oncology) and of Urology, Yale School of Medicine, New Haven, Connecticut

In this 13-minute conversation, Dr. Crawford presents a case of a 55-year-old prostate cancer survivor who experiences a rising PSA five years after radical prostatectomy. Initially diagnosed in 2018 with high-grade prostate cancer (Gleason 9), he underwent surgery with negative margins and has had an undetectable PSA until a recent rise to 0.14. The patient had declined adjuvant radiation and hormone therapy in favor of surveillance and remained continent, potent, and cancer-free for several years.

Despite the low PSA, the panel debates the benefit of a PSMA PET scan, noting the value of establishing a negative baseline for future comparison. They debate both the monetary and psychological cost of treatment and the possibility of initiating radiation to prevent further progression. The panelists highlight the potential of microscopic disease or PSMA-negative phenotypes.

The discussion expands to the role of additional imaging, including Axumin PET and potential MRI fusion to enhance soft tissue resolution. The panel emphasizes the clinical nuances of biochemical recurrence and the systemic challenges of imaging access. Despite varied viewpoints, there is consensus that early intervention offers the best chance for long-term disease control.