This case regards a 66-yr-old man referred to our institution with a serum prostate-specific antigen (PSA) level of 6.5 ng/ml measured during opportunistic prostate cancer (PCa) screening. The patient had mild lower urinary tract symptoms (International Prostate Symptom Score of 4) not requiring treatment. He is sexually active (International Index of Erectile Function-5 score of 24). His family history includes his father, who was diagnosed with intermediate-risk PCa (aged 72 yr) and underwent radiation therapy with no recurrence. The patient's medical comorbidity includes treatment for hypertension (β-blocker), and he has had no previous surgery.
The patient was informed about the benefits and limitations of PSA evaluation and opted for further investigation. Digital rectal examination revealed no palpable nodules. After extensive counselling, the patient decided to undergo prostate biopsy without any further imaging or biomarker investigation. An 18-core transrectal ultrasound (TRUS)-guided prostate biopsy was performed under local anaesthesia. Prostate volume measured at TRUS was 55 cm3.
The pathology report revealed the presence of adenocarcinoma of the prostate in one core from the right lobe. The tumour was Gleason score 3 + 4 (10% pattern 4) and was a 1-mm focus in a single core. To further characterise the disease, multiparametric magnetic resonance imaging of the prostate was subsequently performed and detected a 0.8-cm Prostate Imaging Reporting and Data System class 3 lesion in the right lobe (Fig. 1).
Conflicts of interest
The authors has nothing to disclose.
Division of Oncology/Urology Unit, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
© 2015 European Association of Urology, Published by Elsevier B.V.