Case Studies

1) Radiation Therapy Follow-Up

• 69 year-old, BPH gradual
• PSA rise 1.6 → 4.8 ng/dl
• Abnormal digital rectal exam → Biopsy: Gleason 5+4=9
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2) Small Volume, Low Grade Disease

• 60 year-old
• PSA 3.6
• 5 of 6 right biopsies GS3+3
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3) Active Surveillance Example 1

• (Initial MRI order was for surgical planning)
• 65 year-old
• PSA 3 → 11 over 6 months
• Microfocus of Gleason 3+3
• Initial report : No posterior disease
• Targeted Biopsy consult prompted 2^nd look
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4) Example of Change to Nerve Sparing

• 59 year-old
• PSA 4.3
• standard biopsy: 3+3=6 but large volume left
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5) Extracapsular Extension and Seminal Vesicle Invasion by MRI + Spectroscopy and Pathology

• 59 year-old male
• PSA level: 10
• Clinical staging: T1C
• Blind systematic biopsy results: Gleason: 3+4=7 in the Left prostate
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6) Dynamic Contrast-Enhancement for Biochemical Failure

• Elevated PSA after prostatectomy
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7) MR-Guided Targeted Biopsy

• 63 y/o, PSA 8.8 → 13.2 over 5 years
• All systematic biopsies negative
• Hypointense left anterior lesion with restricted diffusion is moderately suspicious, not in biopsy zone
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8) Benign Disease (Infertility)

• Young man presents with infertility (azospermia)
• Workup and medical history otherwise noncontributory
• Muellerian duct remnant in central upper prostate may obstruct ejaculatory ducts
• Left seminal vesicles are atrophic
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