Prostate adenocarcinoma: anterior tumor on MRI (PI-RADS 5)

Case contributed by Dr Matthew Bastian-Jordan


PSA = 6.8 ng/mL

Patient Data

Age: 50 years
Gender: Male

Multiparametric MRI of the prostate demonstrates an anterior tumor involving the transition zone (TZ) and anterior fibromuscular stroma (AFS): PI-RADS 5.

There is a large smooth homogeneous anterior region of interest in the TZ/AFS. This demonstrates the so called 'smudged or erased charcoal sign'. There is high signal on b1400 DWI and a decrease in ADC to around 700. The lesion enhances early.

MRI guided in bore biopsy performed.

Histopathology report: 

PIN4 staining demonstrates absence of myoepithelial cell staining around the atypical small acini which are also racemase positive. These features support the malignant diagnosis.

On the immunoperoxidase stain some of the acini appear to show Gleason pattern 3. The diagnosis of Gleason 4 + 3 = 7 adenocarcinoma is preferred.


Prostate biopsy - Adenocarcinoma, Gleason 4 + 3 = 7.

Case Discussion

This is an example of a transition zone tumor demonstrating the classic erased charcoal sign.

This can be known as PEATS (prostate evasive anterior tumor).

The T2 grading of this TZ lesion is 5, so the overall grading of PI-RADS v2 is 5.

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Case information

rID: 46481
Published: 6th Jul 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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