Multiparametric MRI images (coronal view) demonstrating PIRADS 5 signal abnormality in the right peripheral zone of the prostate. A PIRADS 4 lesion can also be seen in the right transitional zone.
Images from MRI/US fusion biopsy procedure demonstrating biopsy targeting of the right peripheral zone lesion.
A 64-year-old man with history of elevated PSA (8.5 ng/mL) and previous negative prostate biopsies underwent multiparametric prostate magnetic resonance imaging (MRI). PIRADS 4 and 5 lesions were identified in the transitional and peripheral zones with the latter lesion exhibiting evidence of extracapsular extension. A 12-core template biopsy with additional MRI/ultrasound targeting of lesions identified on MRI demonstrated large-volume Gleason 3+4=7 disease. The patient underwent an uneventful robotic prostatectomy and bilateral pelvic lymph node dissection. Pathology confirmed T3a, N0, M0 Gleason 3+4=7 disease with negative surgical margins. The patient’s PSA at 6 weeks following surgery was undetectable.
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This case was prepared by Alexander Kutikov, MD, of Fox Chase Cancer Center in Philadelphia.
- Suardi N, Gallina A, Lista G, et al. Impact of adjuvant radiation therapy on urinary continence recovery after radical prostatectomy. Eur Urol 2014;65:546-551.
- Den RB, Yousefi K, Trabulsi EJ, et al. Genomic classifier identifies men with adverse pathology after radical prostatectomy who benefit from adjuvant radiation therapy. J Clin Oncol 2015;33:944-951.
Quiz Answer: B
Patients with adverse pathology (positive surgical margins or T3 disease) stand a significant risk of biochemical failure and disease progression. Nevertheless, post-prostatectomy radiation therapy is not without risk.1 Evidence is emerging that genomic classifiers can help in better risk stratifying patients with high-risk pathology following prostatectomy.2