E. David Crawford, MD, presented “PET Tumor Board – Case 4: A Case of a 66-year old Male with Elevated PSA of 9.06 and MRI Showing PI-RADS Category 4 and 5” on July 15, 2025.

How to cite: Crawford, E. David. PET Tumor Board – Case 4: A Case of a 66-year old Male with Elevated PSA of 9.06 and MRI Showing PI-RADS Category 4 and 5. July 15, 2025. Accessed Sep 2025. https://grandroundsinurology.com/pet-tumor-board-session-2-1/

PET Tumor Board – Case 4: A Case of a 66-year old Male with Elevated PSA of 9.06 and MRI Showing PI-RADS Category 4 and 5 – 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, San Diego, California, presents a real-world case, extracting meaningful, applicable learning points. Discussion participants include:

  • Wayne G. Brisbane, MD, Assistant Professor of Urology, University of California, Los Angeles, California
  • Sean P. Collins, MD, PhD, Radiation Oncologist, University of South Florida, Tampa, Florida
  • Sherief H. Gamie, MD, Nuclear Medicine Specialist, Miller Children’s and Women’s Hospital, San Diego, California
  • Andrew W. Hahn, MD, Assistant Professor, The University of Texas MD Anderson Cancer Center, Houston, Texas
  • 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 multidisciplinary discussion of a 66-year-old male with elevated PSA, MRI PIRADS 4 and 5 lesion, large prostate volume, and PSA density of 0.11. Biopsy reveals Grade Group 4 prostate cancer in 3 of 12 cores, CAPRA score of 5, high-risk disease by NCCN criteria, Charlson score of 3, and family history of prostate cancer. MRI identifies suspicious lesions in the right posterior mid and left posterior lateral apex. A targeted biopsy confirms high-grade disease. 

The panelists advocate for PSMA PET imaging to assess nodal involvement, noting that positive findings could influence treatment decisions and consideration of AR pathway inhibitors. Further PET/CT scans note avid lesions in the peripheral and transitional zones and possible capsular and seminal vesicle invasion.

The discussion centers on whether PET findings alter surgical or radiation planning. The group also considers micro-ultrasound, DRE, and seminal vesicle biopsy for preoperative assessment. Systemic therapy implications are discussed, referencing STAMPEDE data and the potential role of ADT plus abiraterone for young patients. The group weighs surgery versus primary radiation, factoring in hormone therapy duration, systemic risk reduction, quality of life, and sequencing of local and systemic treatments. The case remains open, with follow-up planned after patient consultation.