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)

This is a synopsis of a Case-Based Peer Perspectives series featuring Paul M. Yonover, MD, FACS, of Uropartners/SolarisHealth Partners.

Dr. Paul M. Yonover summarized the case of a 66-year-old man who presented to his primary care physician with mild urinary frequency after an elevated serum prostate-specific antigen (PSA) of 22 ng/mL was noted. The patient had an unremarkable family history, except for a diagnosis of breast cancer in his 82-year-old mother. On physical exam, he had excellent performance status and was very active for his age. An MRI of the prostate revealed a 40-gram prostate with no extraprostatic extension or lymph node involvement, but there was one PI-RADS 5 region suspicious for cancer. Dr. Yonover performed an MRI-ultrasound fusion biopsy showing prostate adenocarcinoma, Gleason grade groups 5, 4, and 3 in 9 of 12 samples. Germline genetic testing was negative. Staging CT and bone scans were clear.

Given the patient's age, performance status, prostate size, and pathologic features, Dr. Yonover determined he met National Comprehensive Cancer Network (NCCN) very high-risk criteria based on: 1) clinical T3a disease, 2) presence of grade group 5 disease on biopsy, 3) PSA >20 ng/mL, and 4) >4 cores positive with grade group 4/5 disease. He has multiple high-risk features in addition to meeting the definition of very high risk disease per NCCN guidelines.

*Video synopsis is AI-generated and reviewed by Urology Times editorial staff.