Prostate cancer - extraprostatic extension

Discussion:

This case shows a typical PI-RADS 5 lesion of the right posterolateral peripheral zone (PZpl), a smaller PI-RADS 4 lesion further basal as well as a PI-RADS 3 finding in the left transition zone.

The case also demonstrates, target planning and documentation while doing an MR in-bore biopsy with two different targets.

Histology of the MR in-bore biopsy of the right posterolateral peripheral zone revealed a continuous infiltrate of an acinar adenocarcinoma (modified Gleason Score 4+5=9, G2b, high grade) within the two cores. The core taken from the left transitional zone turned out to be chronic prostatitis.

The patient underwent robot-assisted, laparoscopic, radical prostatovesiculectomy with bilateral pelvic lymphadenectomy about 7 months after mpMRI.

Final histology of the prostatovesiculectomy preparation revealed poorly differentiated acinar adenocarcinoma in both lobes with 95% of the tumor located on the right side. There was right-sided extraprostatic extension, nonfocal infiltration of the periprostatic fatty tissue and perineural invasion.

Grading G3, Gleason score 5+3=8, WHO grade 4.

Seminal vesicles were free of tumor cells.

One of seven lymph nodes of the right pelvic nodes was positive for tumor cells.

Tumor classification: pT3a pN1(1/16) M0 R0.

The patient also has been receiving adjuvant intensity-modulated radiotherapy and androgen deprivation therapy (ADT).

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