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Ashley E. Ross, MD, PhD, Associate Professor and Clinical Director of Polsky Urologic Cancer Institute at Northwestern Medicine, presents this week`s interesting case. Case Information: 63 year old male who was diagnosed with prostate cancer a few years before establishing care with Dr. Ashley Ross. The patient had a prostatectomy of an outside institution and after the prostatectomy, it was discovered that he had locally advanced disease that had seminal vesicle Invasion. There was a positive margin and the patient had higher gleason scores, which was at least in grade group four. The patient first PSA levels after the prostatectomy didn't go to zero and instead it neetered around 0.3