Presentation
Visible hematuria. PSA 3.8. DRE - irregular and firm prostate gland.
Patient Data
Prostate volume 100 ml. PSA density 0.04 ng/ml.
Extensive bilateral PIRADS 5 in the peripheral zones, most pronounced at the mid gland and base with left-sided neurovascular bundle invasion and extension into the base of the left seminal vesicle. The burden is significantly larger on the left and invades the transitional zone.
BPH.
Two pathological left obturator nodes measuring 6 mm and 8 mm. No sinister bone lesion.
Left-sided bladder diverticulum. Sigmoid diverticulosis.
Comment: Bilateral PIRADS 5 (L >R).
Case Discussion
Radiological stage: T3b,N1,Mx
The patient proceeded to prostate biopsy.
Specimen: 1. Right prostate biopsy. 2. Left prostate biopsy.
Macroscopy: 1. Right - six cores up to 20 mm. 2. Left - six cores up to 17 mm.
Microscopy: 1. Right - adenocarcinoma is present, of the usual microacinar type Gleason patterns present: 4, 3 (and tertiary 5) with cribriform pattern 4 Number of cores invaded by tumor: 6 out of 6 Percentage of tissue involved by tumor: 70 %; maximum length in core = 12 mm perineural invasion is not seen. Extraprostatic invasion is not seen.
2. Left - adenocarcinoma is present, of the usual microacinar type. Gleason patterns present: 4, 3 (and tertiary 5) with cribriform pattern 4 Number of cores invaded by tumor: 8 (fragmented) Percentage of tissue involved by tumor: 95 % - maximum length in core = 13 mm perineural invasion is seen. Extraprostatic invasion is not seen Comment: The global combined Gleason score = 9; 4 + 5 (Grade Group = 5).
Diagnosis:
1. Right - adenocarcinoma - combined Gleason score = 9; 4 + 5 (Grade Group = 5).
2. Left - adenocarcinoma - combined Gleason score = 9; 4 + 5 (Grade Group = 5).
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