A 57-year-old male sought consultation for a rising PSA level and two negative transrectal ultrasound guided biopsies of the prostate (TRUS-Bx). His PSA level had increased from 2.1ng/mL to 5.3ng/mL in 2 years. Results of a 12 core sample biopsy obtained because of his rising PSA were negative. Three months earlier, his PSA level had risen to 6.7ng/mL, and a 16 core sample biopsy did not show any abnormalities. He has an American Urological Association (AUA) symptom score of 4, and his Sexual Health Inventory for Men (SHIM) score was 23, both of which are considered normal values.

The patient is in otherwise good health, and results of a digital rectal examination were normal. His only past surgery was an aortic valve replacement. However, results of a Prostate Cancer gene 3 (PCA3) urine test performed after the digital rectal examination were abnormal; the test result was 89, with normal considered to be less than 35. An endorectal coil MRI was considered, but ultimately it was not ordered because of his aortic valve surgery.

A mapping biopsy was performed and a total of 79 cores were obtained.

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The results were as follows:

• Gleason 3+3=6 in 1 out of 79 cores on the left

• Gleason 3+4=7 in 4 out of 79 cores bilateral

•  Gleason 4+3=7 in 5 out of 79 cores bilateral

The patient’s 3D reconstruction is depicted in the slideshow above: Prostate Cancer Case Study: 3D Reconstruction. 3D reconstruction outlines several foci or cancer in the transition zone. The patient was treated with targeted focal therapy. This is the male equivalent of the female lumpectomy. In this case, only the areas of the gland affected by the neoplasm were treated. We ablated this with cryotherapy.

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