Is this intermediate or high-risk prostate cancer and why?
This is high-risk prostate cancer. True, prostate-specific antigen (PSA) level is < 20 ng/mL, but there is histologically proven cancer within both lobes and there was one core with Gleason 8 carcinoma.
Key images:
Focal lesion #1:
T2 moderately hypointense focus with diffusion restriction in the left mid gland (red arrow). There is an indistinct margin of the pseudocapsule (blue arrowhead).
Focal lesion #2:
T2 moderately hypointense focus with diffusion restriction and capsular breach (blue arrow) in the left base of the prostate. Asymmetric T2 moderately hypointense signal intensity in the left central zone (CZ) involving the left ejaculatory duct and extending into the left seminal vesicle (green arrowhead).
Focal lesion #3:
Thin in T2 hypointense lesion with diffusion restriction adjacent to the capsule of the right peripheral posteromedial zone (orange arrow).
Seminal vesicles:
The left seminal vesicle is asymmetrically thickened and hypointense in T2 with focal low signal in ADC suggestive of left seminal vesicle invasion (green arrows).
Findings illustrated on a map.
Biopsy results:
Histology of the US-guided systematic biopsy 4 months before the MRI showed an acinar adenocarcinoma (modified Gleason score 4+4=8, high grade within one core and 3+4=7a low grade within two cores) of the left mid gland and base and a low-grade acinar adenocarcinoma (modified Gleason score 3+3=6) within one core taken from the right lateral base. The 8 remaining biopsy cores were negative.
The results of the systematic biopsy are illustrated.