Ductal prostatic adenocarcinoma: magnetic resonance imaging documenting the effect of hormone-radiotherapy

A 74 years male with hematuria, mass on digital rectal examination, and elevated prostate specific antigen levels (26 ng/ml) underwent prostate MRI. Imaging demonstrated a prostate mass which contained multiple cystic and solid areas. Subsequent biopsy revealed ductal prostate adenocarcinoma with a Gleason grade of 5 + 4 (9). MRI suggested rectal wall invasion, which was confirmed on rectal biopsy. The patient underwent external beam radiotherapy and concomitant hormonal therapy. A follow-up MRI revealed marked response of the tumour to therapy. Based on these findings, a definitive prostatectomy and pelvic exoneration was performed, with excellent surgical result.