PMC9574441_01
Microscopic examination of the prostate biopsy. Sheets and nests of malignant small ovoid cells with intervening stroma and rectal mucosa floating in the adjacent area. Tumor cells have minimal cytoplasm, hyperchromatic mildly pleomorphic nuclei with stippled chromatin, nuclear molding with peripheral palisading, brisk mitotic activity, apoptotic cells, and occasional necrosis. No glandular or tubule formation and no obvious vascular invasion. (A) Hematoxylin and eosin staining (H&E), x40; (B) H&E, x100; (C) H&E, x200; (D) H&E x400.
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CD56 and chromogranin A markers were negative ( Figures 1A-D ).
(A-C) Contrast-enhanced CT of the abdomen showed an enlarged prostate gland with a lobulated appearance.
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Contrast-enhanced computed tomography (CT) scan of the abdomen showed an enlarged prostate gland with a lobulated appearance ( Figures 2A-C ) which was confirmed on multiparametric magnetic resonance imaging (mpMRI). mpMRI of the prostate showed a multilobulated prostatic mass involving all zones, measuring 255 cm3, with invasion to the rectum and bilateral seminal vesicles ( Figures 3A-D ), while CT thorax-abdomen-pelvis ruled out distant metastasis.
MRI of the prostate. (A) Axial T2-weighted image showing an enlarged prostate gland with a multilobulated appearance involving all zones, predominantly the peripheral zone, measuring 7.3 x 7.4 x 9.1 cm (volume: 255 cm3). (B) Post-contrast coronal T1-weighted fat saturation demonstrates peripheral enhancement extending to the capsule of the prostate. (C, D) Post-contrast axial T1-weighted fat saturation exhibiting involvement of the bilateral seminal vesicles and invasion of the rectum.
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Contrast-enhanced computed tomography (CT) scan of the abdomen showed an enlarged prostate gland with a lobulated appearance ( Figures 2A-C ) which was confirmed on multiparametric magnetic resonance imaging (mpMRI). mpMRI of the prostate showed a multilobulated prostatic mass involving all zones, measuring 255 cm3, with invasion to the rectum and bilateral seminal vesicles ( Figures 3A-D ), while CT thorax-abdomen-pelvis ruled out distant metastasis.
(A, B) PET-CT whole-body scan showed an enlarged prostate, measuring 3.5 x 5.6 x 5.1 cm, with an ill-defined hypermetabolic lesion at the right side base of the prostate.
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He underwent restaging positron emission tomography (PET-CT) whole-body scan after 3 cycles of etoposide and cisplatin and had shown a smaller-size prostate (measuring 50 cm3) compared to that before chemotherapy with a hypermetabolic lesion at the right base of the prostate without evidence of distant metastasis ( Figure 4 ).
Table showing the management timeline.
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The patient had completed 4 cycles of chemotherapy and an ongoing 20 fractions of radiotherapy to date ( Figure 5 ).