Case Studies
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1) Radiation Therapy Follow-Up
![Radiation Therapy Follow-Up](/sites/default/files/styles/max_width_009000_360/public/images/radiationTherapy.jpg?itok=obi523wz)
- 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
![Small Volume, Low Grade Disease](/sites/default/files/styles/max_width_009000_360/public/images/smVolLowGradeDisease.jpg?itok=4MNmP9fI)
- 60 year-old
- PSA 3.6
- 5 of 6 right biopsies GS3+3
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3) Active Surveillance Example 1
![Active Surveillance Example 1](/sites/default/files/styles/max_width_009000_360/public/images/activeSurveillance21.jpg?itok=1bqJtD3a)
- (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 2nd look
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4) Example of Change to Nerve Sparing
![Example of Change to Nerve Sparing](/sites/default/files/styles/max_width_009000_360/public/images/nerveSparing.jpg?itok=lqO7o2fi)
- 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
![Extracapsular Extension and Seminal Vesicle Invasion by MRI](/sites/default/files/styles/max_width_009000_360/public/images/extracapsularExtension2.jpg?itok=NPcDA_uk)
- 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
![Dynamic Contrast-Enhancement for Biochemical Failure](/sites/default/files/styles/max_width_009000_360/public/images/dynamicCE2.jpg?itok=pJwkkTX2)
- Elevated PSA after prostatectomy
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7) MR-Guided Targeted Biopsy
![MR-Guided Targeted Biopsy](/sites/default/files/styles/max_width_009000_360/public/images/MRTargetedBiopsy2.jpg?itok=FCWLSnM8)
- 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)
![Benign Disease (Infertility)](/sites/default/files/styles/max_width_009000_360/public/images/infertilityBenignDisease.jpg?itok=1vL_UGPl)
- 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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