Presentation
PSA 15.0. DRE T2 both lobes. Are there any areas to target at biopsy?
Prostate volume 28mls. PSA density 0.54ng/ml.
1.8cm right anterior horn PIRADS 5 focus at the mid gland level. See key image.
Normal seminal vesicles. No pelvic nodes. No bone lesion.
Undescended left testicle. Thin right hydrocele.
Grade 1 anterior spondylolithesis of L5 on S1.
Specimen: Prostatic needle core biopsies.
Macroscopy: 1. Right - six cores up to 19 mm. 2. Left - six cores up to 16 mm. 3. Right targeted - three cores up to 18 mm with fragments.
Microscopy: 1. Right - adenocarcinoma is present, of the usual microacinar type. Gleason patterns present: 4 + 3 Number of cores invaded by tumor: 5 Percentage of tissue involved by tumor: 15 % Perineural invasion is not seen Extraprostatic invasion is not seen
2. Left - benign prostatic tissue only. There is no evidence of neoplasia. 3. Right targeted - adenocarcinoma is present, of the usual microacinar type. Gleason patterns present: 4 + 3 Number of cores invaded by tumor: All (3) Percentage of tissue involved by tumor: 90 % Perineural invasion is not seen Extraprostatic invasion is not seen
Comment: The global combined Gleason score = 7; 4 + 3 (Grade Group =3).
Diagnosis:
1. Right - adenocarcinoma - combined Gleason score = 7; 4 + 3 (Grade Group =3).
2. Left - benign prostatic tissue.
3. Right targeted - combined Gleason score = 7; 4 + 3 (Grade Group =3).
Case Discussion
A clear PIRADS 5 of the anterior horn proven at targeted biopsy to be prostate adenocarcinoma.
MR prostate aids in directing the clinician to targeting the areas of greatest concern with the correct biopsy technique.
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