Radiological Case

Localized Prostate Cancer Recurrence

R. Jeffrey Karnes, MD, FACS; Mohamed E. Ahmed, MBBCh


Appl Radiol. 2021;50(2):32-33. 

In This Article

Case Summary

A 70-year-old man presented with persistent rising prostate specific antigen (PSA) of 3.2ng/mL in July 2020. The patient was post retropubic radical prostatectomy (RRP) for Gleason 3+4=7 in 2006. Subsequently, the patient experienced biochemical recurrences for which he received salvage external beam radiation therapy to the prostate bed in 2007, cryotherapy to the vesicourethral anastomosis in 2015, and external beam radiation therapy to the pelvic lymph nodes in 2016, followed by hormone therapy for approximately one year. In February 2019, the patient's PSA level started to rise to detectable levels at 0.45ng/mL, reaching 1.1ng/mL in July 2019.

A PET/MR scan revealed increased uptake in a perirectal lymph node. In September 2019, the patient underwent MRI-guided cryoablation of this perirectal lymph node. Interestingly, despite treatment, the PSA continued to rise to 2.3 ng/mL in March 2020, and to 3.2 ng/mL in July 2020.

The patient underwent evaluation with MRI of the abdomen and pelvis, C-11 choline PET/CT scan, and Ga-68 PSMA PET/CT scan.