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 Oct 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, presents a case of a 66-year-old man with an elevated prostate-specific antigen (PSA) of approximately 9, an 85-gram prostate, and magnetic resonance imaging (MRI) lesions consistent with Prostate Imaging Reporting and Data System (PI-RADS) 4–5.  Transrectal biopsies  showed Grade Group 4 disease in 3 of 12 cores. The panel recommended biopsy confirmation and subsequent staging with prostate-specific membrane antigen (PSMA) positron emission tomography (PET), which demonstrated avid intraprostatic lesions, possible capsular involvement, and concern for seminal vesicle invasion, with no clear pelvic nodal uptake. Discussion participants include:

  • Wayne G. Brisbane, MD, Assistant Professor of Urology, University of California, Los Angeles, Los Angeles, California
  • Sean P. Collins, MD, PhD, Professor of Radiation Oncology, University of South Florida, Tampa, Florida
  • Andrew W. Hahn, MD, Assistant Professor of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
  • Sherief H. Gamie, MD, Chief & Director Molecular Imaging and Theranostics Professor of Clinical Radiology (UCSD), 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 leads a multidisciplinary discussion of a 66-year-old male with elevated PSA, MRI PI-RADS 4 and 5 lesions, large prostate volume, and a PSA density of 0.11. The panel recommends PSMA PET imaging and PET/CT scans to help guide the most appropriate treatment options. The group weighs surgery versus primary radiation, considering hormone therapy duration, systemic risk reduction, quality of life, and sequencing of local and systemic treatments.