Figure 4.

69-year-old with Gleason 8 (4 + 4) and PSA 4.8 ng/mL. He underwent a prostatectomy at which time extracapsular extension was found. After surgery his PSA was initially undetectable, but within a year had risen to 0.5 ng/mL, with a PSA doubling time of 3.18 months. A technetium bone scan was negative for bone metastasis. ¹¹C-Acetate PET/CT imaging showed a small focus of increased metabolism in the right seminal vesicle bed (yellow arrow), indicating locally residual cancer. There were no involved lymph nodes on the scan and no lesions were seen on the study to suggest distant metastatic disease to the bone or elsewhere. Based on the ¹¹C-Acetate imaging study, the patient underwent IMRT. Radiation therapy was performed to the entire prostate bed region but also with a radiation “boost” targeted to the focal area identified on the imaging study. After radiation therapy, PSA fell to < 0.1 ng/mL and has remained stable at that level for 2.5 years so far.