This case shows a PI-RADS 5 lesion of the right basal posterolateral peripheral zone (PZpl).

An extraprostatic extension can be presumed due to the broad capsular contact.

Histology of the MR in-bore revealed a continuous infiltrate of an acinar adenocarcinoma (modified Gleason score 4+5=9, G2b, high grade) within the two cores.

So far the patient underwent robot-assisted, laparoscopic, radical prostatovesiculectomy with bilateral pelvic lymphadenectomy about 4 months after the prostate MRI.

Final histology of the prostatovesiculectomy preparation revealed poorly differentiated acinar adenocarcinoma with infiltration of the periprostatic fatty tissue and perineural invasion.

There was also infiltration of the seminal vesicles on histology.

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

Tumor classification: pT3b N0 M0 R0.

This case also shows some challenges of multiparametric MRI of the prostate: on first look, both seminal vesicles appear rather inconspicuous and this was also initially reported this way.

What should attract attention, however, is that the tumor is located far up in the base of the prostate with broad contact to the capsule and thus close proximity to the right seminal vesicle.

As mentioned, the patient was R0 resected so far, because of the Gleason 9 and pT3b situation adjuvant radiation therapy has been recommended.