(UroToday.com) As part of a plenary presentation at the European Association of Urology (EAU) Virtual Annual Meeting assessing “Modern prostate cancer imaging in daily practice,” Annika Herlemann, MD, presented the case of a patient who developed biochemical recurrence following radical prostatectomy. At the time of presentation, he was 57 years old with a family history of prostate cancer in his father that was treated with external beam radiotherapy at the age of 72 with subsequent metastatic disease treated with androgen deprivation therapy. The patient had an initial prostate specific antigen (PSA) of 7.2 ng/mL which was subsequently repeated at 7.6 ng/mL. Digital rectal exam demonstrated no lesions, though TRUS demonstrated a 48cc gland with a hypoechoic lesion concerning extraprostatic extension. Subsequent 3T multiparametric magnetic resonance imaging (MRI) demonstrated a PiRADs 5 lesion in the left mid-gland with concerns for extraprostatic spread. The remainder of his medical history was relatively non-contributory, including open appendectomy, hypertension, and mild lower urinary tract symptoms treated with tamsulosin.