Presentation
DRE = abnormal, irregular, lump firm prostate LUTs = frequency, nocturia 1-3. No LUTs medication. No UTI's. No family hx of prostate cancer. PS = 0. Takes Apixaban. PSA 9.18 µg/L .
Patient Data
Prostate volume 33 mls
PSA 9.18 ng/ml
PSA density 0.28 ng/ml2
5 cm focus of avid diffusion restriction in the left prostatic lobe involving both the transitional and peripheral zones. The abnormality extends beyond capsule and invades the base of the left seminal vesicle.
No extension into the contralateral right lobe.
No pelvic nodes. No focal bone lesion.
Colonic diverticulosis.
Case Discussion
Left PIRADS 5 lesion.
Radiological status: T3b,N0,Mx
Histology (from perineal biopsy)
Histology Report
SPECIMEN(s) A Prostate Needle Core Biopsy, Right B Prostate Needle Core Biopsy, Left CLINICAL DETAILS 3.8 cm PIRADS 5 lesion involving both lobes of the anterior gland.
MACROSCOPY A1 - RA target with five needle cores, the largest measuring up to 15 mm. A2 - RM and has two needle cores, the largest measuring up to 15 mm. A3 - RP and has three needle cores, the largest measuring up to 15 mm. B1 - LA target and has six needle cores, the largest measuring up to 16 mm. B2 - LM and has two needle cores, the largest measuring up to 10 mm. B3 - LP and has two needle cores, the largest measuring up to 14 mm.
MICROSCOPY Summary: Tumor type: Acinar adenocarcinoma Gleason sum score: 4 + 3 = 7 (% Pattern 4 focal cribriform) Grade group: 3 Max length in any core: 12mm Tumor site: Both sides Right side: 4/5 cores positive for tumor Left side: 6/6cores positive for tumor Target biopsy [RA &LA] 10 cores positive for tumor Perineural invasion: Present left side Extraprostatic extension: Absent A1: [right anterior, target] Diagnosis: Adenocarcinoma Gleason patterns present in order of frequency: 3,4 (focal cribriform, pattern 4 is 40%) Number of cores invaded by tumor: 4/5 Max length of tumor in any core: 12mm Aggregate total length of tumor: 33mm A2: [right middle] Diagnosis: Benign A3: [right posterior] Diagnosis: Benign B1: [left anterior, target]
Diagnosis: Adenocarcinoma Gleason patterns present in order of frequency: 4,3 Number of cores invaded by tumor: 6/6 Max length of tumor in any core: 12mm Aggregate total length of tumor: 46mm B2: [left middle] Diagnosis: One out of 2 cores containing single duct with HGPIN B3: [left posterior] Diagnosis: Benign
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