sar prostate dfp – teaching case of the week 7/4/16 active

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

DukeCancerInsFtuterajan.gupta@duke.edu

SARProstateDFP–TeachingCaseoftheWeek6/27/16