A 67-year-old man comes to the office for a routine health maintenance evaluation. He feels well and has no specific symptoms. Vital signs are within normal limits. Digital rectal examination reveals a firm prostatic nodule. The patient undergoes transrectal prostate biopsy, and microscopy reveals sheets of tumor cells infiltrating the stroma with no glandular differentiation; the tumor cells have large vesicular nuclei and prominent nucleoli. Imaging shows enlargement of several iliac lymph nodes. Which of the following is the best description of this patient's tumor?

Question

A 67-year-old man comes to the office for a routine health maintenance evaluation.  He feels well and has no specific symptoms.  Vital signs are within normal limits.  Digital rectal examination reveals a firm prostatic nodule.  The patient undergoes transrectal prostate biopsy, and microscopy reveals sheets of tumor cells infiltrating the stroma with no glandular differentiation; the tumor cells have large vesicular nuclei and prominent nucleoli.  Imaging shows enlargement of several iliac lymph nodes.  Which of the following is the best description of this patient's tumor?

Quizplus · Accepted Answer

Prostate cancer is typically diagnosed by transrectal ultrasound-guided biopsy, which uses ultrasound guidance to take multiple core biopsy samples from random locations within the peripheral zone of the prostate. Subsequent histopathologic examination confirms the presence of cancer and determines the degree of glandular architecture abnormality, which is summarized by the Gleason grade. The lowest Gleason grade of 1 is assigned to well-differentiated tumors; these tumors resemble normal prostatic tissue and are generally arranged into small, well-formed, closely packed glands. In contrast, the highest Gleason grade of 5 is assigned to poorly differentiated tumors; these tumors do not resemble normal prostatic tissue and are generally arranged into sheets of invasive cells with no glandular elements. The 2 predominant Gleason grades in the core biopsies are added together to generate the Gleason score (eg, a tumor that is mostly Gleason grade 3 and 4 would have a Gleason score of 7). The higher the Gleason score, the higher the risk of spread outside of the prostate. Staging is a marker of degree of spread from the site of cancer origin. Low stage is seen in those with disease confined to the prostate; a higher stage is seen in those with regional (eg, lymph node) or metastatic (eg, bone) lesions. In this case, the presence of enlarged iliac nodes likely indicates metastases to the regional lymph nodes; therefore, he would have a higher stage of disease. Educational objective: Prostate cancer is graded by Gleason grade, which is a measure of glandular architecture disruption and risk of extra-organ spread; poorly differentiated prostate cancer (eg, no glandular structure) is assigned a high Gleason grade, whereas well-differentiated prostate cancer (eg, well-formed glandular structure) is assigned a low Gleason grade. Staging is a marker of the extent of spread from the primary cancer site; regional lymph node involvement or distant metastases indicate a higher stage of disease.

A 67-Year-Old Man Comes to the Office for a Routine