Prostate cancer - PI-RADS 5

Discussion:

This case demonstrates a PI-RADS 5 lesion of the posterior transition zone and the posteromedial and posterolateral peripheral zone. The case also depicts the “erased charcoal sign”, which refers to an appearance of a homogeneously T2 low-signal lesion in the transition zone of the prostate with indistinct margins. In this case, it is the smudged appearing border between transition and peripheral zones, which is also referred to as “pseudocapsule” or “surgical capsule”.

Histology of the MR-in bore biopsy revealed an infiltrate of an adenocarcinoma (modified Gleason score 4+5=9, high grade) within both cores.

The patient underwent radical retropubic prostatovesiculectomy with pelvic lymphadenectomy.

Final histology of the prostatovesiculectomy preparation revealed poorly differentiated acinar adenocarcinoma in both lobes  (~10% right lobe, ~30% left lobe) with perineural tumor growth.

Gleason score 4+5=9, ISUP grade 5.

Resection margins and seminal vesicles were free from tumor cells.

Tumorclassification: pT2c, pN0, R0.

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