Prostate adenocarcinoma: anterior horn PIRADS 5

Case contributed by Dr Ian Bickle

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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