Imaging and Biomarker Testing Considerations in Prostate Cancer

Imaging and Biomarker Testing Considerations in Prostate Cancer

Opinion
Video

An expert on prostate cancer discusses the clinical application of imaging and biomarker testing for patients with prostate cancer.

Current Time 0:28
Duration 4:56
 

Case #1: A 66-Year-Old-Man with Prostate Cancer

Initial Presentation (June 2022)

  • A 66-year-old man reported mild urinary frequency to his primary care physician

Clinical workup

  • After an elevated serum PSA 22 ng/mL is noted, patient presents to his urologist
  • Family history of breast cancer (patient’s mother diagnosed at age 82)
  • Digital rectal exam (DRE) unremarkable, overall physical exam unremarkable
  • MRI revealed a 40 gm prostate; no extra-prostatic extension, no nodal involvement; 1 ROI, PIRADS-5
  • Transperineal (TP) MRI fusion biopsy demonstrated prostate adenocarcinoma andGleason score 8/Grade Group 4 in 9 of 12 tissue samples and Gleason score 9/Grade Group 5 in the region of interest
  • Germline genetic testing revealed no actionable mutations; CT and bone scan revealed no extra-prostatic involvement.

Initial Treatment (starting July 2022)

  • Patient underwent robotic assisted lap radical prostatectomy (RALP) + PLND; no surgical complications
  • Pathology confirmed GG5 prostate disease with pT3bN1R1 designation
    • Positive surgical margins; 1 of 12 obturator lymph nodes were positive

12-week Follow-up Notes (October 2022)

  • Post-surgical PSA is undetectable at 12 weeks
  • Minimal GSI (<1 pad/day)

 

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