Prostate cancer - staging

Case contributed by Dr Joachim Feger

Presentation

Intermediate-risk prostate cancer. Prostate-specific antigen (PSA) 4.5 ng/mL. Radiation therapy planning.

Patient Data

Age: 80 years
Gender: Male
MRI

bpMRI

Findings:

Quality:  some movement on sagittal images, does not impair diagnostic confidence

Prostate size:    60 x 47 x 52 mm (CC x AP x ML) ≈ 76 mL, PSA density ≈ 0.06 ng/mL2

Hemorrhage:  mild bleeding in the right posterolateral apical peripheral (RA-PZpl) and left posterior transition zone (LM-TZp).

Peripheral zone (PZ):  in T2w hypointense focus (≈ 9mm), markedly hyperintense in b1400 and markedly hypointense in ADC with capsular contact (10-15mm) and a small capsular bulge, otherwise diffuse hypointense

Transition zone (TZ):  heterogeneity, multiple mostly encapsulated BPH nodules, normal surgical capsule

Neurovascular bundles:  symmetric

Seminal vesicles:  no signs of invasion

Lymph nodes:  oval external iliac lymph nodes (up to 6 mm size, smooth margins)

Pelvic bones:  small lesion in the right femoral head very likely bone island, no definite signs of bony metastasis

Sigmoid diverticulosis.

Impression:

A single small lesion in the right apical posterolateral peripheral zone (RA-PZpl), consistent with the histologically proven prostate cancer.

An extraprostatic extension is possible.

MRI putative stage: cT3aNxMx

Annotated image

Key findings:

Hypointense focus in T2w imaging with a small capsular bulge (red arrowheads), markedly hyperintense in b1400 and markedly hypointense in ADC (blue arrowheads).

Biopsy results:

Histology of the US-guided systematic biopsy 2 months prior to the MRI showed an acinar adenocarcinoma (modified Gleason score 4+4=8, high grade within one core and 4+3=7b within two cores)  of the right apical and mid gland. The 9 remaining biopsy cores were negative.

Case Discussion

This case illustrates a histologically proven small prostate cancer.

Histology of the systematic biopsy was showed an acinar adenocarcinoma (modified Gleason Score 4+4=8, grade 3).

MRI was done for radiation therapy planning and staging purposes and shows a single small lesion in the right apical posterolateral peripheral zone and this finding correlates well with the results from the systematic biopsy.

There is a small capsular bulge visible in the axial images consistent with possible extraprostatic extension.

The patient receives intensity-modulated radiotherapy.

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Case information

rID: 74859
Published: 18th Mar 2020
Last edited: 18th Mar 2020
Inclusion in quiz mode: Included