{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T05:20:29Z","timestamp":1764566429271,"version":"3.46.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Prostate-specific antigen (PSA) is a widely used biomarker for prostate cancer (PCa), but its limitations are evident in patients with PSA at boundary level. We present a 61-year-old male with gross hematuria and a PSA level of 7.25 ng\/mL with an fPSA\/tPSA ratio of 0.19, initially suspected of a bladder tumor. Conventional imaging, including ultrasound, CT, and MRI, revealed suspicious prostate and pelvic lesions but failed to delineate the degree of disease involvement. Prostate-specific membrane antigen positron emission tomography\/computed tomography (PSMA PET\/CT) demonstrated extensive multi-organ involvement, including in the pelvic lymph nodes, bone, lung, and pleura, enabling accurate staging. On the basis of PSMA PET\/CT examination, we conducted targeted cognitive fusion biopsy. Biopsy confirmed high-grade acinar adenocarcinoma with Gleason scores of predominantly Gleason score 9 (4 + 5) disease. The patient received chemotherapy with docetaxel and nedaplatin followed by combined endocrine therapy, achieving rapid PSA decline and radiographic disease stabilization. This case demonstrates the insufficiency of PSA as a sole diagnostic marker and highlights the pivotal role of PSMA PET\/CT in detecting occult metastases, assisting in targeted and precise biopsy, guiding staging, and optimizing individualized therapy. Furthermore, these findings emphasize the necessity of a comprehensive radiographic scheme in which conventional imaging provides initial screening and PSMA PET\/CT confirms the extent of disease, ensuring precise diagnosis and tailored treatment for borderline PSA but aggressive PCa.<\/jats:p>","DOI":"10.3389\/fonc.2025.1721477","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T05:16:20Z","timestamp":1764566180000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: High-volume, aggressive prostate cancer with borderline psa levels diagnosed by PSMA PET\/CT\u2013based comprehensive radiographic scheme and cognitive fusion targeted biopsy"],"prefix":"10.3389","volume":"15","author":[{"given":"Yiheng","family":"Zhou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renyuan","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengmeng","family":"Dou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenkai","family":"Bi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neo.2024.101047","article-title":"PLXNA1 confers enzalutamide resistance in prostate cancer via AKT signaling pathway","volume":"57","author":"Hu","year":"2024","journal-title":"Neoplasia"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1158\/0008-5472.Can-20-1965","article-title":"KIF15-mediated stabilization of AR and AR-V7 contributes to enzalutamide resistance in prostate cancer","volume":"81","author":"Gao","year":"2021","journal-title":"Cancer Res"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.679173","article-title":"KIF15 promotes progression of castration resistant prostate cancer by activating EGFR signaling pathway","volume":"11","author":"Gao","year":"2021","journal-title":"Front Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2020.09.042","article-title":"EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. 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