Pathology Case Study – Prostate Trus Bx

Clinical: 68M, rising PSA. TRUS prostate biopsy.

What is your diagnosis?

Review the static images below or interactive digital slide

Fig 1. TRUS prostate Bx - low power

Fig 2. TRUS prostate Bx - medium power

Fig 3. TRUS prostate Bx - high power


Fig 4. TRUS prostate Bx - cytological features, including prominent nuceloli

What is your diagnosis?

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Diagnosis: Prostate adenocarcinoma, Gleason score 3+4(10%)=7

Findings: The core shows partial involvement by prostate adenocarcinoma seen predominantly as small, individual, rounded to slightly irregular glands (Gleason pattern 3), in areas showing fusion of adjacent glands with increased gland complexity (Gleason pattern 4). The cells lining the glands show characteristic nuclear features with nuclear enlargement and crowding with many cells showing prominent nucleoli (see Fig 4.).

Discussion: Prostate cancer is identified by a pathologist using combined low power architectural and higher power cytological findings, while grading of prostate cancer is determined on architectural pattern only and is described using patterns original described by Donald Gleason (Gleason grading pictorial guidelines).

Learning objectives: Review the 2005 ISUP updated Gleason grading guidelines

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