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ACTIVE SURVEILLANCE CANDIDACY & UPGRADING Rajan T. Gupta, M.D. Jamie N. Holtz, B.A. SAR Prostate DFP – Teaching Case of the Week 7/4/16
ACTIVESURVEILLANCECANDIDACY&UPGRADING
RajanT.Gupta,M.D.
JamieN.Holtz,B.A.
SARProstateDFP–TeachingCaseoftheWeek7/4/16
� 68yearoldM� PSAincreased:3ng/mLà5.2ng/mL� PriorTRUS-guidedbiopsy
� Gleason3+3=6in3/12coresonrightandleRbaseandleRapex
� PresentstoDukeformpMRIandevaluaVonofpossibleacVvesurveillancecandidacy
History
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
T2W ADC
DCE-MRI
� FocusoflowT2signalintheanteriorrighttransiVonandperipheralzonescrossingthemidlineatthelevelofthemid-glandwithbroadbasedabutmentalongtheanteriorfibromuscularstroma
� CorrespondingareaoflowADCvalue� Degreeofrestricteddiffusionsuggestshighgradecomponentoftumor
� SuspiciousperfusionkineVcs� PI-RADS5
MRIInterpretaVon
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
� PaVentelectedtoundergoradicalprostatectomy� Finalpathology:Gleason3+4=7� StagepT3awithEPEatthelateralrightmidglandandapexandbladderneck
NextSteps
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
� mpMRIusedtoassessifacVvesurveillance(AS)paVentsareandiftheyremaincandidatesforAS
� Inthiscase,mpMRIrevealedhighergradediseasethanonTRUS-guidedbiopsynecessitaVngASdisconVnuaVonandmoredefiniVvetreatment
� FormoreinformaVon:HoltzJN,TayKJ,PolascikTJ,GuptaRT.IntegraFonofmulFparametricMRIintoacFvesurveillanceofprostatecancer.FutureOncology2016Jun20.[Epubaheadofprint](PMID:27322161)
TeachingPoints
CasecourtesyofRajanT.Gupta,MD;DukeUniversityMedicalCenter
THANKYOU
RajanT.Gupta,M.D.AssociateProfessorofRadiology
Director,AbdominalImagingFellowshipDukeUniversityMedicalCenter
SARProstateDFP–TeachingCaseoftheWeek6/27/16
