TCIA IDProstateDx-01-0001ProstateDx-01-0002ProstateDx-01-0003ProstateDx-01-0004ProstateDx-01-0005ProstateDx-01-0006ProstateDx-01-0007ProstateDx-01-0008ProstateDx-01-0009ProstateDx-01-0010ProstateDx-01-0011ProstateDx-01-0012ProstateDx-01-0013ProstateDx-01-0014ProstateDx-01-0015ProstateDx-01-0016ProstateDx-01-0017ProstateDx-01-0018ProstateDx-01-0019ProstateDx-01-0020ProstateDx-01-0021ProstateDx-01-0022ProstateDx-01-0023ProstateDx-01-0024ProstateDx-01-0025ProstateDx-01-0026ProstateDx-01-0027ProstateDx-01-0028ProstateDx-01-0029ProstateDx-01-0030ProstateDx-01-0031ProstateDx-01-0032ProstateDx-01-0033ProstateDx-01-0034ProstateDx-01-0035ProstateDx-01-0036ProstateDx-01-0037
Historyhistory of prostate cancer and radiation therapy more than 10 years ago; now rising PSANewly diagnosed prostate cancer Clinical diagnosis: Increased PSA.Cancer in the bilateral prostate on core needle biopsy. Gleason score 6 on right, 7 on left; PSA 6.3prostate cancer, biopsy proven, 4+3=7 Gleason score on the left sidebilateral prostate cancer. Gleason score 8; PSA 15diagnosed prostate cancer Gleason's score 7 on recent biopsy; patient on active surveillanceprostate cancer Gleason 3 + 4 and PSA of 13.5prostate cancerprostate cancer on core needle biopsyrising psaProstate cancer; Gleason's score 3+4 prostate cancer; left nodules on digital rectal examIncreased PSA 33 ng/mlGleason 7 PSA 14History of prostate cancer; PSA 60-50celevated PSA 15African-American male with Gleason's score 3+4status post radical prostatectomy; rising PSArising PSA and known prostate cancer for 7 yearsPSA 14increased PSAnewly diagnosed prostate cancer; Gleason 4+4=8/10 prostate cancer; PSA 13.8;status post radical prostatectomy (robot assisted; RARP) for stage T2c prostate cancer; Gleason 7; one year ago. Now rising PSA level (0.2). Radiation therapy is considereda pT3bN0M0, Gleason 4+4 adenocarcinoma of the prostate s/p radical prostatectomy 4 yrs ago, now with a rising PSA. invasive adenocarcinoma T1 C watchful waitingfPSA (21.7 ng/ml)biopsy provenprostate cancer andsuspected bladder wall invasion and possible seminal vesiclesstatus post robotic prostatectomy 6 weeks ago with pT3B. Most recent PSA= 0.6.
Age decade807060505060705060607060506060606060707060608050505070506060607050
Path reportNone availableGross Description The specimen consists of multiple core fragments of tan soft tissue measuring 0.3cm to 1.8cm in length and 0.1cm in diameter. The specimen is submitted in six cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex. PROSTATE 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES AND 20% OF TOTAL TISSUE. PERINEURAL INVASION SEEN. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES AND 90% OF TOTAL TISSUE. PERINEURAL INVASION SEEN. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+4=8/10, INVOLVING ONE OF ONE CORE AND 95% OF TOTAL TISSUE. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING TWO OF MULTIPLE CORES AND 5% OF TOTAL TISSUE. PERINEURAL INVASION SEEN. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES AND 50% OF TOTAL TISSUE. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING ONE OF ONE CORE AND 20% OF TOTAL TISSUE. specimen is submitted entirely in six cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex.-rg 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING THREE OF MULTIPLE CORES, AND 15% OF TOTAL TISSUE. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING ONE OF TWO CORES, AND 5% OF TOTAL TISSUE. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ONE OF ONE CORE, AND 25% OF TOTAL TISSUE. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING THREE OF THREE CORES, AND 60% OF TOTAL TISSUE. PERINEURAL INVASION IS SEEN. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES, AND 70% OF TOTAL TISSUE. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ONE OF ONE CORE, AND 60% OF TOTAL TISSUE. specimen is submitted entirely in six cassettes as follows: 1-right PZ, 2-right PZ/TZ, 3-right apex, 4-left PZ, 5-left PZ/TZ, 6-left apex. Final Diagnosis 1. RIGHT PZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. NOTE: IMMUNOHISTOCHEMISTRY STUDIES PERFORMED ON PARAFFIN EMBEDDED TISSUE BLOCK FOR PIN4 (RACEMASE/K309 AND P63) DID NOT REVEAL A STAINING PATTERN DIAGNOSTIC OF INVASIVE CARCINOMA. 2. RIGHT PZ/TZ: BENIGN PROSTATIC TISSUE WITH CHRONIC INFLAMMATION, NO TUMOR IDENTIFIED. 3. RIGHT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO CORES, ABOUT 60% OF THE TISSUE REPRESENTED. PERINEURAL INVASION IS PRESENT. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO CORES, ABOUT 70% OF THE TISSUE REPRESENTED. PERINEURAL INVASION IS PRESENT. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO CORES, ABOUT 70% OF THE TISSUE REPRESENTED. PERINEURAL INVASION IS PRESENT. specimen consists of multiple brown/tan core biopsies measuring in length from 0.3 cm to 1.8 cm and 0.01 cm in diameter each. The specimen is submitted in toto in seven cassettes as follows: 1 right PZ, 2 right PZ/TZ, 3 right apex, 4 left PZ, 5 left PZ/TZ, 6 left apex, 7 - floater. PROSTATIC CORE NEEDLE BIOPSIES: 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (4+3) =7/10, PRESENT IN APPROXIMATELY 10% OF THE TISSUE SUBMITTED. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (4+4) =8/10, PRESENT IN APPROXIMATELY 10% OF THE TISSUE SUBMITTED. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (4+4) =8/10, PRESENT IN APPROXIMATELY 20% OF THE TISSUE SUBMITTED. 4. LEFT PZ: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. 5. LEFT PZ/TZ: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+4) =7/10, PRESENT IN APPROXIMATELY 10% OF THE TISSUE SUBMITTED. specimen consists of multiple brown/tan core biopsies measuring in length from 0.5 cm to 2.3 cm and 0.1 cm in diameter each. The specimen is submitted in toto in seven cassettes as follows: 1 right PZ, 2 right PZ/TZ, 3 right apex, 4 left PZ, 5 left PZ/TZ, 6 left apex PROSTATE BIOPSIES: 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 1 OF 1 CORE, AND 30% OF TOTAL TISSUE. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING 3 OF 3 CORES, AND 20% OF TOTAL TISSUE. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 1 OF 1 CORE, AND <5% OF TOTAL TISSUE. 4. LEFT PZ: BENIGN PROSTATIC TISSUE. 5. LEFT PZ/TZ: BENIGN PROSTATIC TISSUE. 6. LEFT APEX: BENIGN PROSTATIC TISSUE. 7. FLOATER: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 1 of 2 CORES, AND 20% OF TOTAL TISSUE. and 7 floater.Specimen consists of multiple brown/tan core biopsies measuring in length from 0.3 cm to 2 cm and 0.01 cm in diameter each. The specimen is submitted in toto in six cassettes as follows: 1 right PZ, 2 right PZ/TZ, 3 right apex, 4 left PZ, 5 left PZ/TZ, 6 left apex. Final Diagnosis PROSTATIC CORE NEEDLE BIOPSIES: 1. RIGHT PZ: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+4) =7/10, PRESENT IN APPROXIMATELY 30% OF THE TISSUE SUBMITTED. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+3) =6/10, PRESENT IN LESS THAN 5% OF THE TISSUE SUBMITTED. 4. LEFT PZ: PROSTATIC TISSUE WITH MILD CHRONIC INFLAMMATION. NO TUMOR IDENTIFIED. 5. LEFT PZ/TZ: SINGLE MICROSCOPIC ATYPICAL GLANDULAR FOCUS. 6. LEFT APEX: SCANT PROSTATIC TISSUE. NO TUMOR IDENTIFIED. Radical prostatectomy Prostate Size: Weight: 51.4 g Size: 5X4.5X4.0cm Lymph Node Sampling Pelvic lymph node dissection Histologic Type : Adenocarcinoma (acinar, not otherwise specified) Histologic Grade Gleason Pattern Primary Pattern: Grade 3 Secondary Pattern: Grade 4 Total Gleason Score: 3+4=7/10 Tumor Quantitation: Proportion (percentage) of prostate involved by tumor: 20% Extraprostatic Extension: Present, focal (left anterior lobe at the base) Seminal Vesicle Invasion: Not identified Margins: Margins uninvolved by invasive carcinoma Treatment Effect on Carcinoma: Not identified Lymph-Vascular Invasion: Not identified Perineural Invasion: Present Pathologic Staging (pTNM): Primary Tumor (pT) pT3a Extraprostatic extension or microscopic invasion of bladder neck Regional Lymph Nodes (pN) pN0: No regional lymph node metastasis Specify: Number examined: 26 Number involved: 0 Distant Metastasis (pM) Not applicable Pathologic Staging pT3a pN0 pMx *Additional Pathologic Findings High-grade prostatic intraepithelial neoplasia (PIN) B. PORTION OF LEFT SEMINAL VESICLE: FIBROVASCULAR AND FIBROADPISE TISSUE. NO SEMINAL VESICLE TISSUE IDENTIFIED (ENTIRE SPECIMEN SUBMITTED FOR HISTOLOGICAL EXAMINATION) NO TUMOR IDENTIFIED. C. RIGHT EXTERNAL ILIAC LYMPH NODES: EIGHT (8) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. Addendum Diagnosis IMMUNOSTAIN FOR AE1/AE3 PERFORMED ON BLOCK C1 IS NEGATIVE. IMMUNOSTAIN FOR AE1/AE3 WILL BE EXAMINED AND RESULTS REPORTED IN AN ADDENDUM. D. RIGHT OBTURATOR LYMPH NODES: SEVEN (7) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. E. LEFT EXTERNAL ILIAC LYMPH NODES: FIVE (5) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. F. LEFT OBTURATOR LYMPH NODES: SIX (6) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. G. RIGHT SEMINAL VESICLE: SEMINAL VESICLE TISSUE. NO TUMOR IDENTIFIED. Addendum Diagnosis IMMUNOSTAIN FOR AE1/AE3 PERFORMED ON BLOCK C1 IS NEGATIVE. A: LEFT OBTURATOR LYMPH NODE POCKET B: RIGHT OBTURATOR LYMPH NODE POCKET C: PROSTATE AND SEMINAL VESICLES Final Diagnosis A. LEFT OBTURATOR LYMPH NODE POCKET: FOUR (4) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. B. RIGHT OBTURATOR LYMPH NODE POCKET: FOUR (4) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. C. PROSTATE AND SEMINAL VESICLES: Procedure: Radical prostatectomy Prostate Size: 3.5x3x2.6cm Weight: 30.6g Lymph Node Sampling: Pelvic lymph node dissection Histologic Type: Adenocarcinoma (acinar, not otherwise specified) Histologic Grade: Gleason grade 3+3 score = 6/10 Primary pattern: Grade 3 Secondary pattern: Grade 3 Tumor Quantitation: Proportion (percentage) of prostate involved by tumor: 15% Extraprostatic Extension: Not identified Seminal Vesicle Invasion: Not identified Margins: Margins uninvolved by invasive carcinoma Treatment Effect on Carcinoma: Not identified Lymph-Vascular Invasion: Not identified Perineural Invasion: Present Additional Pathologic Findings: High-grade prostatic intraepithelial neoplasia (PIN) and chronic inflammation Pathologic Staging (pTNM) Primary Tumor (pT) pT2c: Bilateral disease Regional Lymph Nodes (pN) pN0: No regional lymph nodes metastasis Specify: Number examined: 8 Number involved: 0 Distant Metastasis (pM) Pathologic Stage: (pT2c, pN0) The specimen consists of multiple core fragments of tan soft tissue measuring 0.8cm to 1.5cm in length and 0.1cm in diameter. The specimen is submitted entirely in six cassettes. 1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex. PROSTATE: 1-RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+4=8/10, INVOLVING 50% OF THE TISSUE REPRESENTED. 2-RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING 80% OF THE TISSUE REPRESENTED. 3-RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING 50% OF THE TISSUE REPRESENTED. 4-LEFT PZ: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. 5-LEFT PZ/TZ: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. 6-LEFT APEX: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. Gross Description The specimen consists of multiple core fragments of tan soft tissue measuring 0.5cm to 2.3cm in length and 0.1cm in diameter. The specimen is submitted in six cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex. 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING TWO CORES, ABOUT 20% OF TISSUE REPRESENTED. 2. RIGHT PZ/TZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 3. RIGHT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING TWO CORES, ABOUT 30% OF TISSUE REPRESENTED. 5. LEFT PZ/TZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 6. LEFT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED.Gross Description: The specimen consists of multiple core fragments of tan soft tissue measuring 1.4cm to 1.9cm in length and 0.1cm in circumference. The specimen is submitted entirely in six cassettes. PROSTATE: 1-RIGHT PZ: PROSTATE TISSUE WITH FOCAL CHRONIC INFLAMMATION. NO TUMOR IDENTIFIED. 2-RIGHT PZ/TZ: PROSTATIC ADENOCARCINOA, GLEASON SCORE 3+4+7/10, INVOLVING 25% OF THE TISSUE REPRESENTED. 3-RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 1% OF THE TISSUE REPRESENTED. 4-LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING 60% OF THE TISSUE REPRESENTED. 5-LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING 70% OF THE TISSUE REPRESENTED. 6-LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 40% OF THE TISSUE REPRESENTED.The specimen is received fixed in a single container labeled with the patient's name, hospital number and Prostate. The specimen consists of multiple core fragments of tan soft tissue measuring from 1.5cm to 2cm in length and 0.1cm in diameter. The specimen is submitted in six cassettes as follows: 1-right PZ, 2-right PZ TZ, 3-right apex, 4-left PZ, 5-left PZ TZ, 6-left apex.- Specimen(s) Received PROSTATE BIOPSIES: 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 40% OF THE TISSUE EXAMINED (TWO CORES). 2. RIGHT PZ/TZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 30% OF THE TISSUE EXAMINED (TWO CORES). 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 40% OF THE TISSUE EXAMINED (TWO CORES). 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 5% OF THE TISSUE EXAMINED (ONE CORE). 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 40% OF THE TISSUE EXAMINED (TWO CORES). NOTE: PERINEURAL INVASION PRESENT. A. PROSTATE, LEFT APEX: BENIGN PROSTATIC TISSUE. NO TUMOR IDENTIFIED. B. PROSTATE, LEFT APEX LATERAL: BENIGN PROSTATIC TISSUE. NO TUMOR IDENTIFIED. C. PROSTATE, RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON GRADE 3+3 = 6/10, INVOLVING 50% OF THE TISSUE, 1 OF 1 CORE. D. PROSTATE, RIGHT APEX LATERAL: PROSTATIC ADENOCARCINOMA, GLEASON GRADE 3+3 = 6/10, INVOLVING 50% OF THE TISSUE, 1 OF 1 CORE. E. PROSTATE, LEFT MID: BENIGN PROSTATIC TISSUE. NO TUMOR IDENTIFIED. F. PROSTATE, LEFT MID LATERAL: BENIGN PROSTATIC TISSUE. NO TUMOR IDENTIFIED. G. PROSTATE, RIGHT MID: BENIGN PROSTATIC TISSUE. NO TUMOR IDENTIFIED. H. PROSTATE, RIGHT MID LATERAL: PROSTATIC TISSUE WITH FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN). I. PROSTATE, LEFT BASE: BENIGN PROSTATIC TISSUE. NO TUMOR IDENTIFIED. J. PROSTATE, LEFT BASE LATERAL: PROSTATIC ADENOCARCINOMA, GLEASON GRADE 4+3 = 7/10, INVOLVING 15% OF THE TISSUE, 1 OF 1 CORE. K. PROSTATE, RIGHT BASE: BENIGN PROSTATIC TISSUE. NO TUMOR IDENTIFIED. L. PROSTATE, RIGHT BASE LATERAL: BENIGN PROSTATIC TISSUE. NO TUMOR IDENTIFIED1-RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10 INVOLVING 40% OF THE TISSUE REPRESENTED. 2-RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10 INVOLVING 50% OF THE TISSUE REPRESENTED. 3-RIGHT APEX: PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 4-LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10 INVOLVING 60% OF THE TISSUE REPRESENTED. 5-LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10 INVOLVING 30% OF THE TISSUE REPRESENTED. 6-LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10 INVOLVING 15% OF THE TISSUE REPRESENTED.PROSTATE BIOPSIES A. LEFT BASE: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ABOUT 60% OF THE TISSUE SUBMITTED. PERINEURAL INVASION IS PRESENT. HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN) IS PRESENT. B. LEFT LATERAL BASE: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ABOUT 90% OF THE TISSUE SUBMITTED. PERINEURAL INVASION IS PRESENT. C. LEFT MID: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ABOUT 75% OF THE TISSUE SUBMITTED. PERINEURAL INVASION IS PRESENT. D. LEFT LATERAL MID: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ABOUT 80% OF THE TISSUE SUBMITTED. E. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ABOUT 70% OF THE TISSUE SUBMITTED. F. LEFT LATERAL APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING ABOUT 60% OF THE TISSUE SUBMITTED. G. RIGHT BASE: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ABOUT 75% OF THE TISSUE SUBMITTED. H. RIGHT LATERAL BASE: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ABOUT 80% OF THE TISSUE SUBMITTED. I. RIGHT MID: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING ABOUT 60% OF THE TISSUE SUBMITTED. HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN) IS PRESENT. J. RIGHT LATERAL MID: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ABOUT 80% OF THE TISSUE SUBMITTED. HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN) IS PRESENT. K. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ABOUT 70% OF THE TISSUE SUBMITTED. HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA (PIN) IS PRESENT. L. RIGHT LATERAL APEX: BLOOD CLOT ONLY, INSUFFICIENT TISSUE FOR DIAGNOSISThe specimen consists of multiple core fragments of tan soft tissue measuring 1.4cm to 2.1cm in length and 0.1cm in diameter. The specimen is submitted in six cassettes. 1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex. PROSTATE 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES, INVOLVING APPROXIMATELY 80% OF THE TISSUE SUBMITTED. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES, INVOLVING APPROXIMATELY 90% OF THE TISSUE SUBMITTED. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES, INVOLVING APPROXIMATELY 60% OF THE TISSUE SUBMITTED. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING TWO OF TWO CORES, INVOLVING APPROXIMATELY 20% OF THE TISSUE SUBMITTED. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING TWO OF TWO CORES, INVOLVING 20% OF THE TISSUE SUBMITTED. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING TWO OF TWO CORES, INVOLVING APPROXIMATELY 15% OF THE TISSUE SUBMITTED.The specimen consists of multiple core fragments of tan soft tissue measuring 0.2cm to 1.7cm in length and 0.1cm in diameter. The specimen is submitted entirely in six cassettes as follows: 1-right PZ, 2-right PZ TZ, 3-right apex, 4-left PZ, 5-left PZ TZ, 6-left apex. –rg PROSTATE BIOPSIES: 1. RIGHT PZ: PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, PRESENT IN TWO TISSUE CORES (10% OF TISSUE). PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, PRESENT IN TWO TISSUE CORES (30% OF TISSUE). 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, PRESENT IN ONE TISSUE CORE (10% OF TISSUE). 5. LEFT PZ/TZ: PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 6. LEFT APEX: MICROSCOPIC FOCUS OF PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, (<1% OF TISSUE). PIN-4 IMMUNOHISTOCHEMISTRY CONFIRMS THE DIAGNOSISThe specimen consists of multiple core fragments of brown/tan tissue measuring 0.2cm to 1.5cm in length and 0.1cm in diameter. The specimen is submitted entirely in seven cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex, 7-floater.-rg 1. RIGHT PZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 2. RIGHT PZ/TZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 3. RIGHT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+4=8/10, INVOLVING 5% OF THE TISSUE EXAMINED. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+4=8/10, INVOLVING 5% OF THE TISSUE EXAMINED. 6. LEFT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 7. FLOATER: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. The specimen consists of multiple core fragments of tan soft tissue measuring from 0.3cm to 1.8cm in length and 0.1cm in diameter. The specimen is submitted in six cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex.-rg. PROSTATE 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON GRADE 4+3=7/10, INVOLVING TWO CORES, ABOUT 30% OF TISSUE EXAMINED. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON GRADE 4+3=7/10, INVOLVING TWO CORES, ABOUT 10% OF TISSUE EXAMINED (SEE NOTE). 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON GRADE 4+3=7/10, INVOLVING TWO CORES, ABOUT 20% OF TISSUE EXAMINED. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON GRADE 3+3=6/10, INVOLVING ONE CORE, ABOUT 5% OF TISSUE EXAMINED (SEE NOTE). 5. LEFT PZ/TZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 6. LEFT APEX: PROSTATIC TISSUE WITH MICROSCOPIC FOCUS OF ATYPICAL SMALL ACINAR PROLIFERATION (SEE NOTESpecimen consists of multiple core fragments of tan soft tissue measuring 0.5cm to 1.7cm in length and 0.1cm in diameter. The specimen is submitted entirely in six cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex.-rg 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING 80% OF THE TISSUE REPRESENTED. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+4=8/10, INVOLVING 60% OF THE TISSUE REPRESENTED. 3. RIGHT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 4. LEFT PZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 40% OF THE TISSUE REPRESENTED. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 20% OF THE TISSUE REPRESENTED. NOTE: PERINEURAL INVASION IS PRESENT. Gross Description The specimens are received in three containers labeled with the patient' s name, hospital number and A. "Left Pelvic Lymph Nodes", B. "Right Pelvic Lymph Nodes" and C. "Prostate Gland". Specimen A consists of a 4.5x2x0.5 cm single whole fatty lymph node with minimally attached fibroadipose tissue. The lymph node is serially sectioned and the entire specimen is submitted in cassettes as follows: A1 and A2 fatty lymph node, serially sectioned, A3 remaining fibrofatty tissue. Specimen B consists of a 4x2x05. cm piece of fibrofatty tissue from a single whole lymph node dissected which measures 2.5 cm. The entire specimen is submitted in cassettes as follows: B1 and B2 single whole lymph node, serially sectioned, B3 remaining fibrofatty tissue. Specimen C consists of a 42.9 grams, 4x3x2.8 cm radical prostatectomy specimen with bilateral attached vas and seminal vesicles. The right and left seminal vesicles average 4x1.5x0.4 cm, right and left vas average 3.5 cm in length by 0.3 cm in diameter. The specimen is inked as follows: right side black, left side blue. Proximal and distal margins are taken enface and radially sectioned. The specimen is serially sectioned to reveal a 3x2 cm pale-white, hard mass present in the right posterior and left posterior lobe which grossly abuts the overlying inked margin. There is focal cystic present in the left anterior lobe. Representative sections are submitted in cassettes as follows: C1 and C2 radial section, distal urethral margin, C3 and C4 radial section, proximal bladder base margin, C5 right seminal vesicle and right vas, C6 left seminal vesicle and left vas, C7 thru C10 right anterior lobe, inferior to superior, C11 thru C14 right posterior lobe, inferior to superior, C15 thru C18 left posterior lobe, inferior to superior, C19 thru C22 left anterior lobe, inferior to superior. Procedure: Radical Prostatectomy Prostate Size: 4x3x2.8cm. Weight: 42.9g grams Lymph Node Sampling: Pelvic lymph node dissection Histologic Type: Adenocarcinoma (acinar, not otherwise specified) Gleason Score Primary Pattern: 4 Secondary Pattern: 4 Total Gleason Score: 4+4=8/10 Tertiary pattern: 3 (Approximately 15% of the tumor volume) Tumor Quantitation / Proportion of prostate involved by tumor: Approximately 65% Extraprostatic Extension: Present Specify sites: Left posterior and lateral Seminal Vesicle Invasion: Not identified Margins: Margins involved by invasive carcinoma Specify sites: Multifocal, Left posterior and lateral margin Treatment Effect on Carcinoma: Not identified Lymph-Vascular Invasion: Not identified Perineural Invasion: Present Additional Pathologic Findings: Chronic Inflammation AJCC Pathologic Staging (7th ed.): (pT3a, pN0, pMx) pT3a: Extraprostatic extension or microscopic invasion of bladder neck pN0: No regional lymph node metastasis Specify: Number examined: 2 Number involved: 0 pMx Not applicable The specimen consists of multiple core fragments of tan soft tissue measuring 0.3cm to 1.8cm in length and 0.1cm in diameter. The specimen is submitted in six cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex.-rg PROSTATE 1. RIGHT PZ: PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 2. RIGHT PZ/TZ: PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 3. RIGHT APEX: PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING THREE OF MULTIPLE CORE FRAGMENTS, AND APPROXIMATELY 40% OF TISSUE EXAMINED. PERINEURAL INVASION PRESENT. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING TWO OF TWO CORES, AND APPROXIMATELY 70% OF TISSUE EXAMINED. PERINEURAL INVASION PRESENT 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING ONE OF ONE CORE, AND <5% OF TISSUE EXAMINEDThe specimen consists of multiple tan core biopsies measuring in length from 0.8 cm to 2 cm and 0.01 cm in diameter each. The specimen is submitted in toto in seven cassettes as follows: 1 right PZ, 2 right PZ/TZ, 3 right apex, 4 left PZ, 5 left PZ/TZ, 6 left apex, 7 - floater. rg- PROSTATE 1. RIGHT PZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 2. RIGHT PZ/TZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 3. RIGHT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 4. LEFT PZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 2 OF 2 CORES, 50% OF TISSUE REPRESENTED. PERINEURAL INVASION. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 1 OF 3 CORES, 50% OF TISSUE REPRESENTED. 7. FREE FLOATER: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED Active surveillance – no bx or surgery as yet; dx in 7 yrs previous with gleason 6, 7 prostate cancer under active surviellence on finasteride for rising PSA. Most recent PSA in 5.91. The specimen consists of multiple brown/tan core biopsies measuring in length from 1 cm up to 2 cm and 0.01 cm in diameter each. The specimen is submitted in toto in six cassettes as follows: 1 right PZ, 2 right PZ/TZ, 3 right apex, 4 left PZ, 5 left PZ/TZ, 6 left apex. rg- PROSTATE 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING 2 CORES, 90% OF TISSUE EXAMINED. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING 2 CORES, 90% OF TISSUE EXAMINED. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING 2 CORES, 80% OF TISSUE EXAMINED. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING 2 CORES, 60% OF TISSUE EXAMINED. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING 2 CORES, 50% OF TISSUE EXAMINED. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING 2 CORES, 60% OF TISSUE EXAMINED. The specimen consists of multiple brown/tan core biopsies measuring in length from 0.3 cm up to 2 cm and 0.01 cm in diameter each. The specimen is submitted in toto in six cassettes as follows: 1 right PZ, 2 right PZ/TZ, 3 right apex, 4 left PZ, 5 left PZ/TZ, 6 left apex. PROSTATIC CORE NEEDLE BIOPSIES: 1. RIGHT PZ PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+3)=6/10, INVOLVING APPROXIMATELY 15% OF TISSUE REPRESENTED. 2. RIGHT PZ/TZ PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+4) =7/10, INVOLVING APPROXIMATELY 40% OF TISSUE REPRESENTED. 3. RIGHT APEX PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+3) =6/10, INVOLVING APPROXIMATELY 30% OF TISSUE REPRESENTED. 4. LEFT PZ PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+4) =7/10, INVOLVING APPROXIMATELY 30% OF TISSUE REPRESENTED. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+4) =7/10, INVOLVING APPROXIMATELY 40% OF TISSUE REPRESENTED. 6. LEFT APEX PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+4) =7/10, INVOLVING APPROXIMATELY 10% OF TISSUE REPRESENTED. The specimen consists of multiple core fragments of tan soft tissue measuring 0.3cm to 1.5cm in length and 0.1cm in diameter. The specimen is submitted in seven cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex, 7-free floater.-rg PROSTATE: 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 10% OF TISSUE. CHRONIC INFLAMMATION PRESENT. 2. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING <1% OF TISSUE. 3. RIGHT PZ/TZ: FIBROMUSCULAR TISSUE ONLY. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 60% OF TISSUE. 5. LEFT PZ/TZ: FIBROMUSCULAR TISSUE ONLY. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 5% OF TISSUE. 7. FLOATER: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING LESS THAN 5% OF TISSUE.PROSTATE BIOPSY A. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING ONE CORE, ABOUT 35% OF THE TISSUE SUBMITTED. B. LEFT LATERAL APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING ONE CORE, ABOUT 5% OF THE TISSUE SUBMITTED. C. RIGHT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. D. RIGHT LATERAL APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. E. LEFT MID: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING ONE CORE, ABOUT 15% OF THE TISSUE SUBMITTED. F. LEFT LATERAL MID: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING ONE CORE, ABOUT 30% OF THE TISSUE SUBMITTED. G. RIGHT MID: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. H. RIGHT LATERAL MID: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. I. LEFT BASE: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING ONE CORE, ABOUT 40% OF THE TISSUE SUBMITTED. J. LEFT LATERAL BASE: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING ONE CORE, ABOUT 60% OF THE TISSUE SUBMITTED. K. RIGHT BASE: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. L. RIGHT LATERAL BASE: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. The specimen consists of multiple brown core biopsies ranging from 0.5cm to 1.7cm in length and 0.1cm in diameter. The specimen is submitted in seven cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex, 7-floater.-rg PROSTATE 1-right pz, PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 4 = 7/10, INVOLVING ONE CORE, 50% OF TISSUE. 2-right pz/tz, PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 4 = 7/10, INVOLVING TWO CORES, 80% OF TISSUE. 3-right apex, PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 4 = 7/10, INVOLVING TWO CORES, 30% OF TISSUE. 4-left pz, PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4 + 3 = 7/10, INVOLVING MULTIPLE CORES, 70% OF TISSUE. 5-left pz/tz, PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 4 = 7/10, INVOLVING TWO CORES, 80% OF TISSUE. 6-left apex, PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4 + 4 = 8/10, INVOLVING MULTIPLE CORES, 70% OF TISSUE. 7-floater PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4 + 4 = 8/10, INVOLVING ONE CORES, 90% OF TISSUESpecimen(s) Received A: RIGHT VAS DEFERENS B: PROSTATE AND SEMINAL VESICLES A. RIGHT VAS DEFERENS: SEGMENT OF VAS DEFERENS. NO TUMOR IDENTIFIED. B. PROSTATE AND SEMINAL VESICLES: PROSTATIC ADENOCARCINOMA, CONVENTIONAL TYPE. GLEASON GRADE 3+4 SCORE = 7/10. THE TUMOR IS CONFINED TO THE PROSTATE GLAND AND IS BILATERAL WITH PRIMARY INVOLVEMENT OF THE RIGHT LOBE. THE TUMOR OCCUPIES 10% OF THE TOTAL GLAND. EXTRAPROSTATIC EXTENSION NOT NOTED. INVASION OF SEMINAL VESICLES IS NOT IDENTIFIED. PERINEURAL INVASION IS PRESENT. LYMPHOVASCULAR SPACE IS ABSENT. THE SURGICAL MARGINS ARE NEGATIVE. LYMPH NODE SAMPLING: NO LYMPH NODES PRESENT. TREATMENT EFFECT ON CARCINOMA: NOT IDENTIFIED ADDITIONAL PATHOLOGIC FINDINGS: HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA, ACUTE AND CHRONIC INFLAMMATION. COMMENT: AJCC PATHOLOGIC STAGING (pT2c, pNx, pMxConsult with past prostatectomy. At operation 4 yrs ago, Gleason 4+4=8 prostatic adenocarcinoma with bilateral seminal vesicle invasion and extensive perineural invasion. Two right-sided pelvic LNs and two left-sided pelvic LNs were negative, although it seems they contained some sort of hyperplasia. He had a PSA of 0.3 in last yr, and reportedly had one shot of lupron. His PSA in 2 mos later remained 0.3. CT of the A/P on 2 mos ago revealed no evidence of metastases, but noted residual seminal vesicle tissue and scattered subcentimeter pelvic lymph nodes. Repeat PSA on 1 mo ago was 1.9. No further op recomendedThe specimen consists of a prostatectomy specimen with attached left and right seminal vesicles and attached segments of the vas deferens. The specimen weighs 33.5gms and measures 8x4.1x3.8 cm in greatest dimension. The right and left seminal vesicles measure 3.8x2.6x0.8 cm and 3.1x1.9x0.9 cm, respectively. The left vas deferens measures 4.5 cm in length and 0.5 cm in diameter. The right vas deferens measures 4.5 cm in length and 0.4 cm in diameter. The prostate is symmetrical and firm. The right side is inked black and he left side is inked blue. Sectioning reveals no grossly identifiable tumors. The prostatic parenchyma is gray/white and nodular in appearance. Representative sections are submitted in cassettes as follows: 1 distal urethral margin, 2 bladder neck margin, 3 left and right vas deferens margins, 4 left seminal vesicle margin, 5 right seminal vesicle margin, 6 thru 10 left anterior lobe sectioned from apex to base, 11 thru 15 left posterior lobe sectioned from apex to base, 16 thru 19 right anterior lobe sectioned from apex to base, 20 thru 22 right posterior lobe sectioned from apex to base. Specimen(s) Received PROSTATE GLAND PROSTATIC ADENOCARCINOMA, CONVENTIONAL-TYPE. GLEASON GRADE 3+4 SCORE = 7/10. THE TUMOR IS CONFINED TO THE PROSTATE GLAND AND IS BILATERAL. THE TUMOR OCCUPIES 10% OF THE TOTAL GLAND. INVASION OF SEMINAL VESICLES IS NOT IDENTIFIED. PERINEURAL INVASION IS PRESENT. LYMPHOVASCULAR SPACE IS ABSENT. THE SURGICAL MARGINS ARE POSITIVE, (LEFT APICAL AND RIGHT MID POSTERIOR). ADDITIONAL PATHOLOGIC FINDINGS: HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA, CHRONIC INFLAMMATION. AJCC PATHOLOGIC STAGE II (pt2c, pnx, pmx). PROSTATE, LEFT BASE: PROSTATE TISSUE, NO TUMOR IDENTIFIED. B. PROSTATE, LEFT MIDDLE: PROSTATE TISSUE, NO TUMOR IDENTIFIED. C. PROSTATE, LEFT APEX: PROSTATE TISSUE, NO TUMOR IDENTIFIED. D. PROSTATE, RIGHT BASE: PROSTATIC ADENOCARCINOMA, GLEASON GRADE 3+3=6/10 INVOLVING ONE BIOPSY CORE (25% OF TISSUE). E. PROSTATE, RIGHT MIDDLE: PROSTATIC ADENOCARCINOMA, GLEASON GRADE 3+3=6/10 INVOLVING ONE BIOPSY CORE (20% OF TISSUE). F. PROSTATE, RIGHT APEX: PROSTATE TISSUE, NO TUMOR IDENTIFIED. PROSTATE BIOPSIES (A AND B): A. PROSTATE, LEFT, CORE NEEDLE BIOPSIES: PROSTATIC ADENOCARCINOMA, GLEASON GRADE 3+3=6/10 INVOLVING ONE BIOPSY CORE (5% OF TISSUE). IMMUNOPEROXIDASE STAINS (HMWK) AT OUTSIDE HOSPITAL CONFIRMS DX. B. PROSTATE, RIGHT, CORE NEEDLE BIOPSIES: ATYPICAL SMALL ACINAR PROLIFERATION. specimen consists of multiple core fragments of tan and white tissue measuring in length from 0.1 cm to 1.5 cm and 0.1 cm in diameter each. The specimen is submitted in toto in six cassettes as follows: 1 right PZ, 2 right PZ/TZ, 3 right apex, 4 left PZ, 5 left PZ/TZ, and 6 left apex. PROSTATE 1. RIGHT PZ: BENIGN PROSTATIC TISSUE WITH CHRONIC INFLAMMATION. NO TUMOR IDENTIFIED. 2. RIGHT PZ/TZ: BENIGN PROSTATIC TISSUE WITH CHRONIC INFLAMMATION. NO TUMOR IDENTIFIED. 3. RIGHT APEX: BENIGN PROSTATIC TISSUE WITH CHRONIC INFLAMMATION. NO TUMOR IDENTIFIED. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING 50% (ONE CORE) OF TISSUE REPRESENTED. 5. LEFT PZ/TZ: BENIGN PROSTATIC TISSUE WITH CHRONIC INFLAMMATION. NO TUMOR IDENTIFIED. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+4=8/10, INVOLVING 30% (ONE CORE) OF TISSUE REPRESENTED.PROSTATE BIOPSIES A. PROSTATE (RIGHT PZ), NEEDLE CORE BIOPSY PROSTATIC TISSUE. NO TUMOR IDENTIFIED. B. PROSTATE (RIGHT PZ/TZ), NEDDLE CORE BIOPSY: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. C. PROSTATE (RIGHT APEX), NEEDLE CORE BIOPSY PROSTATIC TISSUE. NO TUMOR IDENTIFIED. D. PROSTATE (LEFT PZ), NEEDLE CORE BIOPSY PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4 = 7/10, INVOLVING THREE (3) OF FIVE (5) CORES, APPROXIMATELY 20% OF TISSUE EXAMINED. PERINEURAL INVASION IS IDENTIFIED. E. PROSTATE (LEFT PZ/TZ), NEEDLE CORE BIOPSY: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4 = 7/10, INVOLVING ONE (1) OF THREE(3) CORES, LESS THAN 5% OF TISSUE EXAMINED. F. PROSTATE (LEFT APEX), NEEDLE CORE BIOPSY: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. A: PROSTATE AND RIGHT SEMINAL VESICLE B: RIGHT INTERNAL ILIAC AND OBTURATOR NODES C: LEFT INTERNAL ILIAC AND OBTURATOR NODES D: LEFT SEMINAL VESICLE E: BASE OF PROSTATE A. PROSTATE AND RIGHT SEMINAL VESICLE: Procedure Radical prostatectomy Prostate Size: Weight: 42.1grams Size: 4.2 x 4.1x 4.1 cm Lymph Node Sampling: Pelvic lymph node dissection Histologic Type: Adenocarcinoma (acinar, not otherwise specified) Histologic Grade: Primary Pattern: Grade 4 Secondary Pattern Grade 3 Total Gleason Score: 7 Tumor Quantitation: Proportion (percentage) of prostate involved by tumor: 80% Extraprostatic Extension: Present, Focal. Seminal Vesicle Invasion: Present. Margins Margin(s) involved by invasive carcinoma: Bladder neck Treatment Effect of Carcinoma Not identified Lymph-Vascular Invasion Not identified Perineural Invasion Present Pathologic Staging (pTNM) Primary Tumor (pT) pT3: Extraprostatic extension pT3b: Seminal vesicle invasion Regional Lymph Nodes (pN) pN0: No regional lymph node metastasis Specify: Number involved: 0 Distant Metastasis (pM) pMx: Not applicable Additional Pathologic Findings: High-grade prostatic intraepithelial neoplasia (PIN), Chronic Inflammation
MRI reportProstate has a maximal lateral diameter of 5.2 cm, a maximal craniocaudal diameter of 3.6 cm and a maximal AP diameter of 2.8 cm resulting in an estimated gland volume of 27 cc. The zonal anatomy is preserved. In the mid third of the prostate, in the anterior aspect of the right paramedian central gland, at 11 o'clock, there is a irregular 13 x 14 mm area of suspicious enhancement, suggestive for malignancy (series 701 slice location 27-36). On the T2-W images the mass abuts the fibromuscular band and there is asymmetric bulging. There is also suspicious enhancement beyond the deviated fibromuscular band in this location. Beginning extraprostatic extension very likely. Series 501 slice location 33-36. The peripheral zones show no evidence of malignancy. No evidence for involvement of the neurovascular bundle on either side. The seminal vesicles and show diffuse low signal on the T2 weighted images; however the anatomy of the seminal vesicles with thin walls and regular vesicles seems to be preserved; there is no suspicious enhancement seen within the vesicles or within the walls. Therefore this T2 hypo intensity most likely caused by radiation. Seminal vesicles infiltration unlikely. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1) 1.4cm mass in the right anterior paramedian central gland, mid third of the prostate, as detailed above. Findings are highly suspicious for beginning extraprostatic extension (beyond the fibromuscular band) at 11 o'clock. 2) No evidence for involvement of the neurovascular bundle on either side. 3) No evidence of seminal vesicles infiltration. 4) No suspiciously enlarged obturator and iliac lymph nodes.prostate has a maximal lateral diameter of 5.2 cm, a maximal craniocaudal diameter of 5.2 cm and a maximal AP diameter of 3.0 cm resulting in an estimated gland volume of 42 cc. Status post TURP. Due to expected TURP changes the zonal anatomy not preserved. There is a bilateral tumor seen in the left and right posterior peripheral zone from with measuring in its max. extension approx. 4.0 x 2.0 cm (the dominant mass in the upper third/base from 4-8 o'clock) (Image 20 series 501). There is tumor extension involving midthird and apical third (all three levels are involved bilaterally). No evidence for involvement of the neurovascular bundle on either side. There is seminal vesicles infiltration (bilateral the seminal vesicle base is infiltrated (Images 22-24 series 501. Image 15 series 401). No manifest involvement of bladder neck (slightly obscured due to TURP changes. No involvement of rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1) Bilateral prostate cancer with seminal vesicles infiltration. 2) The dominant mass measures 4.0 x 2.0 cm, located in left and right posterior peripheral zones of the prostate base. The tumor extents from base, through midthird into the apex and infiltrates the seminal vesicles infiltration. 3) No manifest involvement of bladder neck (slightly obscured due to TURP changes). 4) No involvement of rectal wall. 5) No suspiciously enlarged obturator or iliac lymph nodes. 6) St. post TURP, with expected defect. prostate has a maximal lateral diameter of 4.1 cm, a maximal craniocaudal diameter of 3.7 cm and a maximal AP diameter of 2.6 cm resulting in an estimated gland volume of 21 cc. The zonal anatomy is preserved. There signs of chronic prostatitis bilaterally. In the right lobe, midthird peripheral zone at 8 o'clock there is a small area of irregular geographic T2 hypointensity with highly suspicious enhancement (rapid wash-in, rapid wash out) on dynamic contrast enhanced sequences compatible with tumor (series 501 image 10). In the left midthird to the apex peripheral zone, at 5 o'clock, there is a geographic region of T2 hypointensity with suspicious contrast enhancement (series 704 image 59). Tumor extends to the capsule bilaterally and there may be capsular infiltration between 7 o'clock and 5 o'clock. There is no manifest extracapsular tumor mass. No evidence for involvement of the neurovascular bundle on either side. Seminal vesicles are partially collapsed, which limits detection for tumor infiltration. There are slightly thickened walls. No discrete intraluminal tumor masses. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1. Bilateral prostate cancer. Right midthird peripheral zone 7 o'clock infiltrative tumor abutting the capsule. Left midthird to the apex peripheral zone, at 5 o'clock infiltrative tumor abutting the capsule. There is possible capsular infiltration between 7 o'clock and 5 o'clock. 2. No manifest extracapsular tumor mass or neurovascular bundle involvement. 3. Minimally filled seminal vesicles limiting evaluation for tumor infiltration, although there are no intraluminal tumor massesProstate measures 5.8 x 3.7 x 4.5 cm (estimated volume: 50 cc). There is a large mass seen predominantly on the left side involving the peripheral zone of the base, midthird and apex as well the central gland of the left (approx 50% of the gland are involved). The mass crosses the midline several times especially in midthird and apex and involves right peripheral zone and right central gland. The mass abuts the urethra in the apex, with signs of infiltration of the urethra. (series 501 slice location 15 image 6). Imaging findings are suggestive for extraprostatic disease at 1) the apex (median) , 2) at the left internal sphincter, with beginning involvement of the muscle, 3) anteriorly beyond the fibromuscular band at the apex and midthird and 4) at the level of midthird and apex the tumor (median and paramedian left) abuts the Denonvilliers fascia (series 501/slice location 21/ image 8). No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck. No suspiciously enlarged obturator and iliac lymph nodes. prostate has a maximal lateral diameter of 4.9 cm, a maximal craniocaudal diameter of 3.6 cm and a maximal AP diameter of 3.1 cm resulting in an estimated gland volume of 28 cc. The zonal anatomy is preserved. There is a background of chronic prostatitis. On the T2-weighted images, there is T2 hypointensity from apex to base involving the nearly the entire right peripheral zone. On dynamic contrast-enhanced sequences, there is highly suspicious early wash-in and rapid washout compatible with tumor, which extends to the capsule. At the mid-third level, posterior lateral right at 7 o'clock, there is minimal extracapsular disease with radial extension of up to 1 mm. (series 601, image 11), with possible beginning neurovascular involvement. On the left, the anterior aspect of the peripheral zone from the mid one-third to apical third, there is an area of T2 hypointensity. This region demonstrates highly suspicious contrast enhancement with peak wash in and a rapid wash out suspicious for tumor. This extends to the capsule and there is extracapsular invasion posterior lateral at 5 o'clock, without definite tumor extension beyond the "capsule" (series 601 image 10), at 4 o'clock. In the apex at 3 o'clock possible capsular infiltration without extraprostatic tumor masses. ( as annotated on PACS). No evidence for seminal vesicles infiltration. Seminal vesicles are thin-walled, with intraluminal fluid. No intraluminal masses. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1) Bilateral prostate cancer, with highly suspicion of extracapsular extension on the right, and possible beginning extraprostatic extension on the left. (Right peripheral zone infiltration from apex to base with extracapsular extension (radial extension 1 mm) and suspicion for neurovascular bundle involvement. Left anterior peripheral zone tumor from midthird to apical third with possible beginning extracapsular extension at midthird 5 o clock and apex 3 o'clock.) 2) No seminal vesicles involvement. 3) No pelvic lymphadenopathy. prostate has a maximal lateral diameter of 5.6 cm, a maximal craniocaudal diameter of 4.5 cm and a maximal AP diameter of 4.1 cm resulting in an estimated gland volume of 54 cc. The zonal anatomy is preserved. There is a 11 x 9 x 9 mm T2-hypo intense dominant mass seen in the right posterior lateral peripheral zone of prostate base and midthird. The mass shows suspicious enhancement, which is confined to the prostatic borders. The adjacent right neurovascular bundle is not involved. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. There is a prominent venous plexus. There is BPH. IMPRESSION: Right sided prostate cancer in the mid third and base of the prostate, with dominant nodule (11 x 9 x 9 mm) in the right posterior lateral peripheral zone. No evidence of extracapsular extension. There is a prominent venous plexus. prostate has a maximal lateral diameter of 4.8 cm, a maximal craniocaudal diameter of 3.8 cm and a maximal AP diameter of 3.2 cm resulting in an estimated gland volume of 30 cc. The zonal anatomy is preserved. There is a 1.5 x 0.9 cm T-2 W hypointense mass seen in the right posterior-lateral peripheral zone in the mid third of the prostate extending into the apex of the prostate, with suspicious enhancement (rapid wash in and out).This nodule abuts the capsule at the level of mid third and apical third, however there is no extraprostatic tumor or enhancement seen at that levels. At the right posterior lateral apex there asymmetric irregular T2-W hypointense tissue with suspicious enhancement seen, with indistinct borders to the surrounding fatty tissue: beginning extraprostatic extension right posterior lateral at the apex of the prostate possible. There are several small sub 5 mm areas of indeterminate enhancement seen in the left peripheral zone of the mid and upper third of the prostate, therefore multifocality possible, however the dominant nodule clearly on the right side, and these small areas could also represent chronic prostatitis. No evidence for involvement of the neurovascular bundle on either side. No definite seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. There are several up to 9 mm rounded lymph nodes seen on the iliac levels on both sides, beginning just above the obturator muscles up to the bifurcation. Some show a fatty hilum. IMPRESSION: 1) Right sided prostate cancer with the dominant nodule (1.5 x 0.9 cm) in the midthird and apical third of the prostate in the posterior lateral peripheral zone. Possible beginning extraprostatic extension at the posterior lateral right apex. Several up to 9 mm iliac lymph nodes bilateral, of unknown significance. No evidence of seminal vesicle infiltration or involvement of bladder neck or rectum. 2) BPH, Chronic prostatitis. prostate has a maximal lateral diameter of 4.8 cm, a maximal craniocaudal diameter of 4.3 cm and a maximal AP diameter of 2.2 cm resulting in an estimated gland volume of 25 cc. The zonal anatomy is preserved There is a T2-w hypointense nodule seen in the left base/midthird measuring 11 x 7 x 15 mm, in the posterior lateral peripheral zone at 4-6 o'clock. There is associated suspicious enhancement. This is highly suspicious for prostate cancer. The adjacent "capsule" shows also increased enhancement, which suggests capsular infiltration. No manifest tumor mass seen beyond the capsule. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. (bilateral <5 mm iliac lymph nodes) Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: 1) 1.5 cm tumor in the left posterior lateral peripheral zone, with dominant nodule in base and midthird, with capsular infiltration, however, there are no manifest tumor masses beyond the capsule seen. 2) No evidence for right sided tumor. 3) No evidence of seminal vesicle infiltration or lymphadenopathy. prostate has a maximal lateral diameter of 4.6 cm, a maximal craniocaudal diameter of 3.7 cm and a maximal AP diameter of 2.2 cm resulting in an estimated gland volume of 20 cc. The zonal anatomy is preserved. In the midthird and apical third the prostate there are geographic areas of low signal on the T2-weighted images in the posterior aspects of the peripheral zones of both side between 5:00 and 8:00. The dominant area measures 18 x 6 mm and is located in the midthird paramedian right between 6 and 8:00 and extents into the apical third. This area shows also suspicious kinetics on the dynamic series.The area abuts the "pseudo-capsule" posterior and posterior lateral. However, there is NO evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes; several up to 7 x 4 mm obturator lymph nodes seen, on both sides. IMPRESSION: 1) Bilateral tumor, predominantly on the right within the posterior and posterior lateral peripheral zones between 5 and 8 o'clock, in mid third and apical third of the prostate, as detailed above (significant images are annotated on PACS). 2) No evidence of extraprostatic disease - specifically no evidence of extension into the neuro-vascular bundles of either side. prostate has a maximal lateral diameter of 4.5 cm, a maximal craniocaudal diameter of 4.2 cm and a maximal AP diameter of 2.8 cm resulting in an estimated gland volume of 28 cc. The zonal anatomy is preserved. In the mid third of the prostate, in the right posterior lateral peripheral zone between 6:00 and 10:00 there is a geographic 2.0 x 1.8 cm hypointense mass seen which shows rapid wash-in and washout on the dynamic series.(slice location 39; series 501; 401 and 701-709). There is bulging of the tumor at 8-10 o'clock towards the pubo-rectal sling, which seems not to be involved since there is a thin fatty line preserved between tumor and muscle. No manifest extraprostatic tumor mass seen. ("capsular infiltration" is likely). The right neuro vascular bundle seems not to be involved. The tumor extends to the apical and upper third of the prostate. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam;performed by radiologist. IMPRESSION: 2 cm bulging mass in the right posterior and lateral peripheral zone of the midthird of the prostate, with extension into the upper third and lower (apical third); with likely "capsular infiltration" in proximity to the right pubo-rectal sling (at level of mid third) , without manifest extracapsular extension. No evidence of neurovascular bundles involvement. No seminal vesicles infiltration.The prostate has a maximal lateral diameter of 4.7cm, a maximal craniocaudal diameter of 3.9cm and a maximal AP diameter of 2.7 cm resulting in an estimated gland volume of 26 cc. The zonal anatomy is preserved. The entire prostate shows on the T2-weighted images a diffuse fine linear and fine nodular hypointense signal alterations compatible with chronic prostatitis. Smallest foci (smaller than 4 mm) of cancer cannot be excluded. On the dynamic contrast-enhanced series there is a 1.7 x 0.7 cm area of suspicious wash-in and washout seen in the left peripheral zone between 9 and 6:00 in the prostate base and midthird. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1) 1.7 cm area of highly suspicious enhancement in the left posterior lateral (between 9-6 o clock) peripheral zone of the midthird and base of the prostate. 2) On the background of diffuse chronic prostatitis. Small foci of cancer on the right cannot be excluded (smaller than 4 mm). 3) No evidence of extraprostatic disease on either side. Unremarkable Seminal vesicles 4) No pelvic lymphadenopathy. The prostate has a maximal lateral diameter of 4.7 cm, a maximal craniocaudal diameter of 4.6 cm and a maximal AP diameter of 2.6 cm resulting in an estimated gland volume of 29 cc. The zonal anatomy is preserved. There is T2-hypointense signal seen in the posterior and posterior lateral peripheral zone, mid third and apical third, bilateral.(more on the left). Largest dominant nodule on the left is 11 x 13 mm at 5 o'clock apical peripheral zone; the largest dominant nodule on the right is seen in at 8 o'clock mid third of the prostate (also peripheral zone) measuring 7 x 6 mm. These areas show suspicious enhancement curves on the dynamic series. No evidence for involvement of the neurovascular bundle on either side.No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes.IMPRESSION: Bilateral (left more than right) prostate cancer in the midthird and apical third of the prostate within the peripheral zones. No MRI evidence of extraprostatic extension. FINDINGS: The prostate gland measures 5.0 (TV) x 3.3 (AP) x 3.5 (CC) cm and the prostate volume measures 30.0 cc. The zonal anatomy of the prostate gland is preserved. There is diffuse low T2 signal in left and right posterolateral peripheral zones (PZ) with a dominate nodule in the right posterolateral peripheral zone measuring 2.0 x 0.8 cm in the mid third of the gland and dominant nodule in the left posterolateral PZ measuring 1.2 x 1.0 cm. The posterolateral nodules extend to the prostatic capsule without definitive extracapsular extension. An additional nodule is visualized and the anterior aspect of the left peripheral zone at the 2:00 position which bulges the capsule with no definite extracapsular involvement. Within these areas, suspicious contrast enhancement is visualized with a rapid wash-in and washout pattern. No neurovascular involvement is visualized. The seminal vesicles are not involved. The urinary bladder and rectum are uninvolved. A prominent venous plexus is visualized. There is benign prostatic hypertrophy. The diagnostic value of the lymph node sequences is reduced secondary to extensive air and stool throughout the large bowel. A right obturator lymph node is visualized measuring 0.8 x 0.5 cm (slice location 50, series 701). No suspicious bone marrow signal abnormalities are seen. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: 1. Bilateral prostate cancer, left greater than right, with no manifest extracapsular extension; capsular infiltration, especially left posterior lateral towards the left neurovascular bundle, is possible. No MRI evidence of neurovascular bundle or seminal vesicle involvement. 2. Limited evaluation for pelvic lymphadenopathy secondary to the bowel and stool-filled colon. Indeterminate 8 mm right obturator lymph node (superior lateral to the right seminal vesicles); recommend CT of the pelvis for further evaluation. 3. Benign prostatic hypertrophy. FINDINGS: The prostate has a maximal lateral diameter of 6.3 cm, a maximal craniocaudal diameter of 5.7 cm and a maximal AP diameter of 4.9 cm resulting in an estimated gland volume of 91 cc. The zonal anatomy is preserved. There is a prominent middle lobe due to marked BPH. There is a large suspiciously enhancing tumor seen in the right posterior lateral peripheral zone involving all 3 levels of the prostate from base to apex. Measuring approximately 3.6 x 1.6 x 2.4 cm. At the base the tumor crosses the midline into the left peripheral zone. At the apex and lower midthird, posterior lateral at the 7-8 o'clock position there is capsular infiltration present without manifest tumor mass extending beyond the capsule. (slice location a 33 series 501). There is a large prominent middle lobe present. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: 1) 3.6 cm tumor in the right peripheral zone with capsular infiltration posterior lateral at 7-8 o'clock in the lower mid third and apex, as described above. 2) No evidence of manifest extracapsular decease. 3) No evidence of involvement of the neurovascular bundles on either side, however if nerve sparing is planned, this should be considered only on the left side due to the proximity of the tumor to the right neurovascular bundle and the capsular infiltration on that side. No involvement of the seminal vesicles. No lymphadenopathy. 4) Marked BPH with prominent middle lobe; Prostate volume estimated 91 ccFINDINGS: The prostate has a maximal lateral diameter of 5.6cm, a maximal cranio-caudal diameter of 4.2cm and a maximal AP diameter of 4.5 cm resulting in an estimated gland volume of 55 cc. The zonal anatomy is preserved. The central gland shows moderate BPH. In the right peripheral zone, posterior lateral, from 7-9 o'clock, in the mid third of the prostate with extension into the base there is a 2.4 x 0.9 cm tumor seen. The pseudocapsule at the right neurovascular bundle cannot be delineated continuously and appears irregular; Within the neurovascular bundle itself no manifest tumor mass seen. In the left peripheral zone ,within the apical third, (with extension to the midthird) and in predominantly in the left apex, there is a second mass seen between 3-6 o'clock, measuring 1.9 x 1.6 cm. At 9:00 at the apex this tumor mass cannot be delineated from the pubo-rectal sling/superior edge of the internal sphincter and abuts the urethra. At this point no extraprostatic disease visualized. However, tumor extents to apical margin and lateral margin of the gland. Extraprostatic extension is to be expected soon. No evidence for involvement of the neurovascular bundle on the left side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. There is a 4 x 7 mm perirectal lymph node seen at 10 o'clock, one centimeter posterior to the right seminal vesicles. IMPRESSION: 1) Bilateral Prostate Cancer with a dominant mass in the right posterior lateral mid-third of the prostate, and a second dominant mass in the left apex. 2) Beginning capsular infiltration at the right neurovascular bundle likely, without manifest extracapsular disease. If nerve sparing is performed, right side should be excluded, left sided nerve sparing is possible. 3) No definite extraprostatic extension at the left apex, however, tumor mass reaches the margins of the gland apical and lateral. 4) Oval 4 x 7 mm right perirectal lymph node at 10 o'clock; just one cm posterior to the right seminal vesicles. This is an unspecific finding. Otherwise, no enlarged or suspicious obturator or iliac lymph nodes on either side. 5) No Seminal vesicles infiltration, no involvement of Urinary bladder or rectum. FINDINGS: The prostate has a maximal lateral diameter of 4.5 cm, a maximal craniocaudal diameter of 3.1 cm and a maximal AP diameter of 2.6 cm resulting in an estimated gland volume of 20 cc. The zonal anatomy is not clearly preserved. The entire prostate including central gland and bilateral peripheral zones show on the T2 weighted images diffuse hypo-intense signal alterations. There is also diffuse suspicious enhancement seen, involving diffusely the entire gland. At the left recto-prostatic angle, just below the seminal vesicals, the prostate border appears irregular and spiculated. (Slight location 33 series 401). This irregular border is seen only in the upper third (base) and is adjacent to the left neurovascular bundle. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator or iliac lymph nodes. The osseous structures of the pelvic ring show diffuse geographic T2 and T1 weighted signal alteration with foci of atypical enhancement. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: 1) MRI findings suggestive for bilateral prostate cancer with diffuse involvement of the entire gland. The (Findings could be altered by prior therapy (status post radiation therapy?) and or diffuse high grade PIN mixed with cancerous tissue.) Beginning extracapsular extension at the left base posterior lateral likely. 2) Diffuse geographic MR-signal alterations of the osseous structures of the pelvic ring. Further assessment with bone scan/SPECT/PET/CT needed to assess for metastatic disease. 3) No evidence of seminal vesicles infiltration. FINDINGS: The prostate has a maximal lateral diameter of 5.5 cm, a maximal craniocaudal diameter of 3.7 cm and a maximal AP diameter of 3.9 cm resulting in an estimated gland volume of 41 cc. The zonal anatomy is preserved. Due to an enlarged right central gland the midline deviated to the left. There is a large right central gland tumor seen in the mid third and apical third of the prostate, involving on several levels nearly the entire right lobe. There is midline deviation with deviation and partial compression of the prostatic urethra. There is bulging towards the right inner obturator muscle. The tumor extends into the right posterior lateral and posterior peripheral zones bilateral. (at the midthird and apical level of the prostate). The tumor further extends anteriorly into the fibro-muscular band. At the right apex there is asymmetric suspiciously enhancing prostate tissue measuring 1.4 x 1.2 cm in transverse plane , highly suspicious for extraglandular extension. No evidence for manifest involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. No MRI evidence for involvement of osseous structures, as far as visualized. IMPRESSION: 1) Large predominantly right central gland tumor at midthird and apical third of prostate (as detailed above). Findings are suggestive for extracapsular extension at the right anterior lateral apex. (series 401, 601, 605, 606, slice location 21-27; annotations are saved on PACS). 2) No evidence for manifest involvement of the neurovascular bundle on either side. 3) No evidence for manifest seminal vesicles infiltration. 4) No evidence of involvement of bladder neck and rectal wall. 5) No suspiciously enlarged obturator and iliac lymph nodes. 6) No MRI evidence for malignant involvement of osseous structures, as far as visualized. FINDINGS: The prostate has a maximal lateral diameter of 5.0 cm, a maximal craniocaudal diameter of 4.6 cm and a maximal AP diameter of 3.5 cm resulting in an estimated gland volume of 42 cc. The zonal anatomy is preserved. There is a 1.6 x 1.2 cm geographic area of hypo intense signal seen on T2-weighed images, with suspicions wash in and wash out on the contrast enhanced dynamic series, in the right posterior lateral peripheral zone between 6-9 o'clock, with dominant nodule in the mid third of the prostate, which also involves adjacent areas of the central gland. The tumor extends into the base and apical third; at the level of the apical third, there is suspicious enhancement bilateral in the posterior aspects of the gland. There is no evidence of extraglandular extension. Late enhancement of diffuse centripetal pseudo septations diffuse in the peripheral zones of both sides, suggestive for chronic prostatitis. Nodularity in the central gland suggestive for BPH. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: Bilateral Tumor with dominant nodule in the right peripheral zone, in the mid third of the prostate, as detailed above. No evidence of extraglandular extension. No evidence of seminal vesicle infiltration or involvement of the neurovascular bundle on either side. No pelvic lymphadenopathy. Moderate chronic prostatitis. Moderate BPH. Incidental note is made of sigma diverticulosis. FINDINGS: The prostate gland measures 4.8 (TV) x 3.1 (AP) x 3.3 (CC) cm and the prostate volume measures 25.5 cc.The zonal anatomy of the prostate gland is preserved. In the base and mid-third of the left posterolateral peripheral zone, geographic areas of low T2 hypointensity are visualized from the 4-6 o'clock positions with associated suspicious wash-in and washout genetics on dynamic postgadolinium images. The dominant nodule measures 1.8 (TV) x 0.8 (AP) cm in maximal dimension. The left posterolateral mass closely approximates the left neurovascular bundle with no definite involvement. No definite extracapsular involvement is seen. Rectum wall and Bladder neck are unremarkable. Mild benign prostatic hypertrophy and chronic prostatitis are visualized. The seminal vesicles are unremarkable. A small 4 mm round left perirectal lymph node is visualized to adjacent to the left obturator internus (slice location 48, series 601). No obturator or iliac lymphadenopathy. No suspicious bone marrow signal abnormalities are seen. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: 1. Left posterolateral prostate cancer involving the base and middle third of the gland without evidence of extraglandular disease. No MRI evidence of neurovascular bundle involvement or seminal vesicle involvement. No pelvic lymphadenopathy. 2. Mild benign prostatic hypertrophy and moderate chronic prostatitis. FINDINGS: Status post TURP. There is a diffuse T2-weighted hypointense signal alterations seen the right peripheral zone and a smaller portion of the right central gland, predominantly in the midthird and base, with suspicious rapid wash in and wash out on the dynamic series. This is suspicious for malignancy. There is no extracapsular disease seen into the periprostatic tissues. The seminal vesicles show bilateral T2-hypointense signal, which abnormal enhancement on the dynamic series. This is suspicious for seminal vesicles infiltration. No evidence for involvement of the neurovascular bundle on either side. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: 1) Imaging findings suggestive for predominantly right-sided tumor without evidence of extraglandular extension into periprostatic tissues. No involvement of the neurovascular bundles on either side. However, there is abnormal enhancement and abnormal T2-weighted hypointense signal in the seminal vesicles, which is suggestive for seminal vesicles infiltration. No suspiciously enlarged obturator and iliac lymph nodes. 2) Status post TURP; 3) BPHIndication: patient with Gleason 8 prostate cancer; PSA 15; Preoperative assessment for extraglandular extension and staging. FINDINGS: The prostate has a maximal lateral diameter of 4.8 cm, a maximal craniocaudal diameter of 3.8 cm and a maximal AP diameter of 2.9 cm resulting in an estimated gland volume of 28 cc. The zonal anatomy is preserved. Within the midthird of the prostate, with extension into the apical third on the left and right and left prostate base, in left and right posteriorly lateral peripheral zones, there areas of irregular, geographic T-2 weighted high pole intense signal seen, which show along the dynamic contrast-enhanced series suspicious enhancement was rapid wash in and wash out pattern, especially on the right side, the enhancement pattern is suspicious for more aggressive tumor. The left side however shows suspicious enhancement, too. The dominant nodule on the right side measures 15 x 9 mm on the left side 12 x 7 mm. Capsular infiltration on the right is possible. No manifest extraglandular disease on either side. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: 1) Findings suggestive for bilateral cancer in the left and right peripheral zones of right and left base, right and left midthird, and left apical third, as detailed above. 2) No evidence of definite extracapsular disease on either side. Neurovascular bundles and seminal vesicles uninvolved. 3) No local/pelvic lymphadenopathy (up to the aortic bifurcation).FINDINGS: The prostate has a maximal lateral diameter of 4.7 cm, a maximal craniocaudal diameter of 3.4 cm and a maximal AP diameter of 3.1 cm resulting in an estimated gland volume of 29.7 cc. The zonal anatomy is preserved. In the left peripheral zone involving all 3 levels of the prostate (base, mid third and apex), between 2;00 and 7:00, with involvement of the paramedian right peripheral zone there is a homogeneously hypointense geographic area seen (maximal extension of dominant tumor in the axial plane is 2.8 x 1.2 cm), which shows suspicious wash-in and wash-out kinetics on the dynamic series. The pseudocapsule adjacent to the left neural vascular bundle is irregular and thickened and there is suspicious enhancement seen within the pseudocapsule and with a radial extension of 1 mm there are several small areas of suspicious enhancement extending beyond the pseudocapsule at the left prostate base. In the left apex the tumor reaches the gland borders periurethral. No evidence for involvement of the right neurovascular bundle. No evidence for seminal vesicles infiltration; the tumor reaches up to the left seminal vesicle base, without evidence of direct infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes (up to the aortic bifurcation). Incidental note is made of diverticulosis. IMPRESSION: Prostate cancer within the left peripheral zone, and to a lesser extent in the paramedian right peripheral zone, involving all three levels of the prostate. Findings are suspicious for beginning extraprostatic extension at the base towards the left neurovascular bundle. (radial extension 1 mm). At the left apex the tumor reaches the gland borders, at the base the tumor reaches the left seminal vesicles base. No without evidence of direct infiltration of seminal vesicles on either side. No evidence of right neurovascular bundle involvement. No evidence of rectal wall or urinary bladder involvement. No pelvic lymphadenopathy. FINDINGS: The prostate has a maximal lateral diameter of 5.3 cm, a maximal craniocaudal diameter of 4.0 cm and a maximal AP diameter of 3.0 cm resulting in an estimated gland volume of 33 cc. The zonal anatomy is preserved. There is a large 3.3 x 2.5 x 2.7 tumor seen in the left upper third (base) of the prostate with extracapsular extension posterior lateral into the left neurovascular bundle/recto prostatic angle just below the left seminal vesicles. There is manifest seminal vesicle infiltration (1.4 x 1.4 cm) at the left seminal vesicle base. No evidence for involvement of the right neurovascular bundle. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes; there is a 6 mm rounded very dense left iliac lymph node posterior to the vasa iliaca and superior-lateral to the right seminal vesicles; This does not meet the size criteria of suspiciously enlarged pelvic lymph nodes. IMPRESSION: 1) 3.3 cm left prostate tumor at the base with manifest (1.4cm) left seminal vesicles infiltration and extraglandular extension into the left recto-prostatic angle at the base. 2) Indeterminate 6 mm left iliac lymph node. Regular findings seen within the surgical bed. Multiple surgical clips within the prostatic bed and around the anastomosis. Regular appearance of the anastomosis. No definite masses seen within the prostatic bed. No foci of suspicious enhancement in and around the prostatic bed. Unremarkable urinary bladder and bladder neck. Small seroma posterior lateral to the right bladder neck; just superior to the anastomosis. Remnant left seminal vesicles present Series 601 slice location 69-84. No tumor masses seen within the remnant seminal vesicles or suspicious enhancement, No suspiciously enlarged obturator and iliac lymph nodes. Several small lymph nodes seen along the iliac vessel, the largest located just below the bifurcation median presacral measuring 8 x 6 mm without MRI visible fatty hilum ( series 701 slice location 126) The largest obturator nodes measures 3-4 mm. The visualized osseous structures without evidence of involvement. IMPRESSION: 1) remnant left seminal vesicles, without evidence of malignancy. 2) No suspicious masses. 3) No enlarged obturator or iliac lymph nodes, with one presacral (median line) lymph node just below the bifurcation measuring 8 x 6 mm, without distinct fatty hilum. This is of uncertain significance. 4) Normal appearance of the prostatic bed and anastomosis, with expected post surgical changes (including a small seroma). The prostate has a maximal lateral diameter of 4.4 cm, a maximal craniocaudal diameter of 4.2 cm and a maximal AP diameter of 3.0 cm resulting in an estimated gland volume of 29 cc. The zonal anatomy is preserved. In the left posterior lateral peripheral zone, mid third of the prostate, between 4 and 5:00 there is a geographic 9 x 7 mm T2-hypointense area seen, which shows suspicious wash-in and washout kinetics on the dynamic series. (slice location 24, image 67, series 1205; precise location 39 image 14 series 401; please note that the slice location is not consistent since the patient was repositioned during the exam). The adjacent neurovascular bundle is not involved. No evidence of extracapsular extension. There is the same level (image 67 series 1205) there is a second 6 x 5 mm area of suspicious T2- Hypointensity and geographic configuration with suspicious enhancement seen in the anterior centrum gland anteriorly paramedian, just posterior to the fibromuscular band. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration.No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1) 7 x 9 mm tumor in the left peripheral zone, midthird of the prostate. Possible second small 6 mm focus in the paramedian right anterior central gland posterior to the fibromuscular band. 2) No evidence of extraglandular disease. Neurovascular bundles uninvolved. 3) No evidence for seminal vesicles infiltration. 4) No suspiciously enlarged obturator and iliac lymph nodes.FINDINGS: The zonal anatomy is preserved. There is an aprrox. 2.3 x 1.7 cm mass seen in the right posterior and lateral peripheral zone of the mid third and apex with extension to the base. The mass abuts the obturator muscle and the right neurovascular bundle. Extracapsular extension at the right apex and beginning neurovascular involvement, as well as beginning involvement of the right obturator muscle are possible. There is a second smaller mass, 0.7 x 1.1 cm, seen in the left lateral peripheral zone, at the midthird and upper apical third of the prostate No evidence of extraprostatic extension on the left. No evidence for involvement of the left neurovascular bundle. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: Bilateral cancer, with larger mass on the right, as detailed above. Extracapsular extension into apex and right neurovascular bundle is possible. Tumor also abuts the right obturator muscle. No evidence of infiltration of left neurovascular bundle or seminal vesicles. No local pelvic lymphadenopathy. FINDINGS: The prostate has a maximal lateral diameter of 5.4 cm, a maximal craniocaudal diameter of 4.8 cm and a maximal AP diameter of 3.1 cm resulting in an estimated gland volume of 42 cc. There is marked BPH present; there is also a prominent 3.0 x 3.1 cm middle lobe present with protrusion into the bladder neck. The zonal anatomy is preserved. In the midthird of the prostate within the lateral and posterior lateral left peripheral zone there is a geographic area of T2-weighted hypo- intense signal with partial rapid wash in and wash out kinetics on the dynamic series; the dominant nodule within the left posterior lateral peripheral zone measures approximately 2 x 1 cm. In the right posterior lateral peripheral zone of the lower mid third/apical third of the prostate there is a second dominant nodule seen in measuring 8 x 9 mm, with suspicious wash in and wash out genetics on the dynamic series and nodular T2-weighted hypointense signal, similar to the nodule in the left peripheral zone. In addition, there are several small areas of diffuse hypointense signal alteration on the T2-weighted images with abnormal kinetics seen, mostly in the left peripheral zone of base midthird and apical third, and to a lesser extent in the right peripheral zone, within areas of hemorrhagic changes caused by the recent biopsy. There is no evidence of manifest extra-capsular extension or seminal vesicle infiltration. The neurovascular bundles seem not to be involved on either side. There are no suspicious the enlarged obturator or iliac lymph nodes seen on either side. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: Bilateral prostate cancer with left sided dominance, without evidence of extraglandular disease, as detailed above. No MRI evidence of neurovascular bundle involvement on either side. No seminal vesicles involvement. No pelvic lymphadenopathy. Marked BPH with prominent middle lobe. FINDINGS: The prostate has a maximal lateral diameter of 4.5 cm, a maximal craniocaudal diameter of 3.9 cm and a maximal AP diameter of 3.4 cm resulting in an estimated gland volume of 31 cc. The zonal anatomy is preserved. Within the prostate base (upper third) with extension into the mid third and apical third there is diffuse T2-weighted signal alteration seen in the posterior and posterior lateral left peripheral zone and to a lesser extent in the right posterior peripheral zone (paramedian right) between 3 and 7 o'clock. Within these areas there is suspicious contrast enhancement seen, with rapid wash-in and wash-out pattern. These findings are suggestive for bilateral prostate cancer with dominant nodule in the left upper third. The dominant nodule on the left measures 1.7 x 1.1 cm. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: Bilateral prostate cancer with left-sided dominance, without evidence of extraglandular extension. The dominant nodule in the left prostate base measuring max. 1.7 cm. No evidence of neurovascular bundle involvement on either side, or seminal vesicles infiltration. No pelvic lymphadenopathy on MRI 2.7 cm dominant mass in the left prostate base, in the posterior lateral peripheral zone with imaging findings suggestive of beginning extracapsular extension posterior-posterior-lateral with proximity to the left neurovascular bundle (prostate base). Irregular signal and enhancement of the left seminal vesicle base (adjacent to the primary tumor/dominant mass with in the left prostate base) suggestive of beginning seminal vesicle infiltration. The seminal vesicles show bilateral atrophy, and do not show regular thin walled fluid filled vesicles on either side. The left seminal vesicles base; the vesicles which are directly superior and adjacent to the tumor within left posterior lateral prostate show suspicious enhancement on the contrast enhanced images. Imaging findings suggestive for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes.FINDINGS: The prostate has a maximal lateral diameter of 4.6 cm, a maximal craniocaudal diameter of 4.6cm and a maximal AP diameter of 3.3 cm resulting in an estimated gland volume of 36 cc. The zonal anatomy is not preserved, due to history of TURP. There is a large tumor seen involving most of the prostate base, with extension through midthird and apical third, involving the entire left lobe, and most of the right lobe of the prostate at this level and extension into both lobes of the apical third and further extension into the left apex. Imaging findings are suggestive of seminal vesicles infiltration with involvement of the paramedian aspects (base) the right seminal vesicles. There is tumor extension into the periprostatic fat in the midline (in between the seminal vesicles) Se 401 SL 54-57; Se 301 SL 36-42. No evidence for involvement of the neurovascular bundle on either side. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: 1) Large tumor involving approximately 75% of the prostate gland, with extension into left apex. 2) Imaging findings suggestive of manifest seminal vesicles infiltration of the right seminal vesicles base. (Se 401 SL 54-57; Se 301 SL 36-42), and extension into the periprostatic fat tissue between the seminal vesicles (midline). 3) Neuro-vascular bundles not involved. 4) No suspiciously enlarged obturator or iliac lymph nodesFINDINGS: Regular findings seen within the surgical bed. Multiple surgical clips within the prostatic bed and around the anastomosis. Regular appearance of the anastomosis. No definite masses seen within the prostatic bed. No foci of suspicious enhancement in and around the prostatic bed. Unremarkable urinary bladder. No remnant seminal vesicles present. No suspiciously enlarged obturator and iliac lymph nodes. Several small lymph nodes seen along the iliac vessels bilateral and peri-rectal, non larger than 5 mm. The visualized osseous structures without evidence of involvement. IMPRESSION: No suspicious mass in the prostatic bed. No enlarged obturator or iliac lymph nodes. Normal appearance of the prostatic bed and anastomosis.Regular surgical bed. Regular appearance of the anastomosis. No definite masses seen within the prostatic bed. No foci of suspicious enhancement in and around the prostatic bed. Unremarkable urinary bladder. There are remnant seminal vesicles present - on both sides. No suspiciously enlarged obturator and iliac lymph nodes. The visualized osseous structures without evidence of metastasis IMPRESSION: No suspicious mass. No enlarged obturator or iliac lymph nodes. Normal appearance of the prostatic bed and anastomosis. There are remnant seminal vesicles bilateral. Indication: Patient is status post radical prostatectomy. Now with rising PSA. Pre planning examination. FINDINGS: Regular findings seen within the surgical bed. Multiple surgical clips within the prostatic bed and around the anastomosis. Regular appearance of the anastomosis. No definite masses seen within the prostatic bed. No foci of suspicious enhancement in and around the prostatic bed. Unremarkable urinary bladder. No remnant seminal vesicles present. No suspiciously enlarged obturator and iliac lymph nodes. The visualized osseous structures without evidence of involvement. IMPRESSION: Expected post surgical appearance of the prostatic bed and anastomosis. No suspicious mass in the surgical bed. No enlarged obturator or iliac lymph nodes. The prostate has a maximal lateral diameter of 5.5 cm, a maximal craniocaudal diameter of 4.1 cm and a maximal AP diameter of 3.2 cm resulting in an estimated gland volume of 38 cc. The zonal anatomy is preserved. There is diffuse linear (centrifugal configured) enhancement throughout the prostate, suggestive for marked chronic prostatitis. Slightly obscured by the enhancement pattern of the chronic prostatitis, there are several small foci of suspicious enhancement in the mid prostate and prostate base, in the right and left peripheral zone - compatible with small cancer foci. No foci larger than 5 mm. (the largest in the right upper posterior lateral peripheral zone with a max diameter of 5 mm) There is minimal BPH. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. Diffuse patchy and geographic signal change of the visualized osseus structures on the T1-weighted images (hypo-intense), less likely associated with prostate cancer. Clinical correlation and bone scan recommended for further evaluation. IMPRESSION: 1) Possible multifocal bilateral prostate cancer with small sub 5 mm foci. No evidence of local extraprostatic disease. 2) Marked Chronic prostatitis. 3) Mild BPH. 4) Diffuse patchy and geographic signal change of the visualized osseus structures (pelvic ring, spine) on the T1-weighted images, less likely associated with prostate cancer. Clinical correlation and bone scan recommended for further evaluation. The prostate has a maximal lateral diameter of 6.2 cm, a maximal craniocaudal diameter of 4.7 cm and a maximal AP diameter of 4.3 cm resulting in an estimated gland volume of 65 cc. The zonal anatomy is preserved. There is BPH. On the T2-W images there is an area of hypo-intense tissue in the left posterior lateral (4-6 o'clock) Peripheral Zone Upper and Mid Third of the prostate measuring approximately 2.1 x 1.7 cm. This area shows highly suspicious contrast enhancement. The capsule in this area is irregular and bulging. On the dynamic series there is suspicious enhancement within the mass, the capsule and beyond the capsule (radial extension 2 mm). The left neurovascular bundle might be infiltrated. (Series 501 slice location 33-42) There is an additional smaller area with hypo intense tissue in the right posterior lateral peripheral zone ( 6-8 o'clock), upper (base) and midthird of the prostate with suspicious enhancement on the dynamic series. No evidence for involvement of the neurovascular bundle on the right side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. (the largest iliac lymph nodes are 5 mm - on both sides). IMPRESSION: Bilateral Prostate Cancer (left and right peripheral zones) with dominant mass (2 cm) in the left posterior lateral Peripheral Zone (5 o'clock); midthird of the prostate. Findings are suggestive for early extracapsular extension (radial extension 2 mm) at 5 o'clock; midthird of the prostate; with possible involvement of the left neurovascular bundle. There is no manifest extracapsular extension on the right side. No evidence of Seminal Vesicles infiltration.The prostate has a maximal lateral diameter of 6.5 cm, a maximal craniocaudal diameter of 7.5cm with prominent median lobe protruding into bladder neck; and a maximal AP diameter of 5.6 cm resulting in an estimated gland volume of 141 cc. The zonal anatomy is preserved, however there is a markedly enlarged central gland with a very large median lobe protruding into the bladder neck, consistent with marked BPH. There are several small irregular areas of T2-hyperintensity with suspicious contrast enhancement. in the posterior lateral left and right peripheral zone at 4-5 o'clock and 7-8 o'clock, respectively, in the mid and upper third of the prostate. Capsular infiltration is possible on both sides. Minimal extracapsular extension is more likely on the left side (left posterior lateral peripheral zone; mid third at 5 o'clock). In addition suspicious area of enhancement in the midthird of the prostate in the right central gland and a small area in the left aspect of the median lobe. No evidence for involvement of the neurovascular bundle on either side. There is minimal enhancement at the seminal vesicles based on both sides, however, manifest seminal vesicles infiltration is not visualized. No evidence of involvement of urinary bladder neck and rectal wall. (The lobulated enhancement of the bladder neck on CT, was caused by the prominent median lobe of the prostate). No suspiciously enlarged obturator lymph nodes. There is a 10 x 8 mm rounded left iliac lymph node just above level of the upper seminal vesicles and a second 10 x 6 mm lymph node (both just posterior to the left iliac vein. The lymph nodes do not show a fatty hilum. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: 1) Multifocal possible bilateral prostate cancer with capsular infiltration and possible minimal extracapsular extension more likely on the left (ECE possible left posterior lateral). 2) No involvement of the neurovascular bundle on either side. 3) No manifest infiltration of the seminal vesicles. Beginning infiltration of the seminal vesicle basis is possible. 4) No involvement of the bladder neck. 5) Two adjacent 10 mm left iliac lymph nodes without fatty hilum posterior/dorsal to the left iliac vein just above the level of the upper aspect of the seminal vesicles) 6) Very large prostate (141 cc) due to marked BPH and large median lobe protruding into the bladder neck. Regular findings seen within the surgical bed. Multiple surgical clips within the prostatic bed and around the anastomosis, which obscure (due to expected artifacts) some portions of the surgical bed. Regular appearance of the anastomosis. No definite masses seen within the prostatic bed. No foci of suspicious enhancement in and around the prostatic bed. Unremarkable urinary bladder. No remnant seminal vesicles present. No suspiciously enlarged obturator and iliac lymph nodes. Several small lymph nodes all sub 5 mm seen along the iliac vessels, The there is a perirectal round lymph node on the left at 9 o'clock, which measures 4 mm. The visualized osseous structures without evidence of malignant involvement. Incidental note is made of Sigma diverticulosis. IMPRESSION: 1) No manifest residual tumor; no discrete mass. 2) No remnant seminal vesicls. 3) Expected appearance of the prostatic bed and anastomosis (after surgery 6 weeks ago). 4) No enlarged obturator or iliac lymph nodes. Small 4 mm left perirectal lymph node, of unknown significance. 5) Incidental note is made of Sigma diverticulosis.