Recurrent prostate cancer 6 years after brachytherapy and external beam radiation in 63-year-old patient with PSA 11.44 ng/ml. Recurrent prostate cancer identified in right posterior base was upgraded from Gleason score 3 + 4 on template biopsy to Gleason 4 + 3 on targeted biopsy. A, CT. B, PET. C, fused PET-CT. D, prostate needle core biopsy. E, prostatic adenocarcinoma, Gleason score 4 + 3 = 7 (Grade Group 3). H&E, reduced from ×100. F, note perineural invasion focus. H&E, reduced from ×400.