Figure 3.

76-year-old with Prostate Adenocarcinoma (PCa), Gleason score was 8 (4 + 4) and PSA was 4.0. He underwent prostatectomy with PSA remaining < 0.1 for several years. His PSA then began to rise, 3.3 ng/mL and PSA doubling at a rate of 10.9 months. ¹¹C-Acetate PET/CT imaging showed a small recurrence of cancer in the prostate bed (yellow arrow). No involved lymph nodes were detected and no lesions were seen on the study to suggest distant metastatic disease. Based on the results of the ¹¹C-Acetate imaging study, the patient proceeded with Intensity Modulated Radiation Therapy (IMRT) to the prostate bed. The radiation therapy plan was modified from the standard “blind” application of radiation to this region. Instead, the area of recurrent cancer identified on the imaging study was targeted by the radiation and less radiation was then given to the surrounding areas, including the urinary bladder and rectum. After radiation treatment, the PSA fell to < 0.1 ng/mL and has remained stable at that level for 4 years. He experienced no side effects from the radiation treatment and no additional treatment has thus far been necessary.