Robotic Salvage Seminal Vesiculectomy for radio-recurrent prostate cancer post LDR brachytherapy following multiple negative trans-perineal biopsies.

Multi-parametric Magnetic Resonance Imaging (mp-MRI) and prostate membrane specific antigen positron emission tomography (PSMA-PET) CT scan in prostate cancer has led to enhanced detection of local and metastatic recurrence post-radiotherapy. A 59-year-old man presented with biochemical relapse following low dose rate brachytherapy for ISUP 2 T1cN0M0 prostate cancer (PCa). Despite strong biochemical and radiological evidence of radio-recurrent PCa in his right seminal vesicle, serial transperineal biopsies revealed benign tissue. He proceeded to Robot Assisted Salvage Seminal Vesiculectomy (RSSV) as a diagnostic procedure without complication. Histo-pathology confirmed a 23 × 17 × 13mm focus of Gleason 4 + 4 adenocarcinoma in the SV with clear surgical margins.

The evolving role of multi-parametric MRI in the evaluation of bladder cancer: Revealing what lies beneath the surface.

Conventional staging for bladder cancer involves CT and TURBT, and is thought to understage up to fifty-percent of T1 tumours. This report details the case of a 64-year-old male who whilst on cystoscopic surveillance for high grade bladder cancer, underwent a multi-parametric MRI Bladder due to clinical suspicion of occult muscle invasive disease. Despite minimal urothelial changes at cystoscopy, MRI demonstrated a well-defined T3 lesion. The patient proceeded to radical cystectomy and final pathology verified the MRI findings. The role of MRI in bladder cancer is yet to be defined but should be considered if clinical suspicion for understaging exists.