Metastatic T3/T4 prostate adenocarcinoma

Case contributed by Dr Ian Bickle

Presentation

PSA 47 ng/mL. Hard prostate on PR exam.

Patient Data

Age: 80 years
Gender: Male

Prostate volume 77 mL.   PSA density 0.61 ng/mL.

Extensive PI-RADS 5 changes in the peripheral zones (right more than left) most pronounced posterior in the TRUS biopsy field.

Neurovascular bundle, extracapsular and seminal vesicle invasion with prostatic tissue abutting, if not invading the anterior aspect of the rectum.

Gross pelvic and left para-aortic lymphadenopathy.

No bone metastases.

Large right inguinal hernia containing bowel.  Small left inguinal hernia.

Case Discussion

Prostate adenocarcinoma.   Radiological stage:  T3b/T4,N1,Mx

Specimen: Prostatic needle core biopsies.

Macroscopy: 1. Right - three cores up to 17 mm. 2. Left - three cores up to 17 mm.

Microscopy:

1. Right - adenocarcinoma is present, of the usual microacinar type Gleason patterns present: 4 + 5 Number of cores invaded by tumor: All Percentage of tissue involved by tumor: 90 % Perineural invasion is seen Extraprostatic invasion is not seen

2. Left - adenocarcinoma is present, of the usual microacinar type. Gleason patterns present: 4 + 5 Number of cores invaded by tumor: All Percentage of tissue involved by tumor: 90 % 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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