Nhân một trường hợp ung thư tuyến tiền liệt phát hiện sau 6 lần sinh thiết

Abstract

Objective: To report a challenging case of prostate cancer (PCa) diagnosed after multiple negative systematic biopsies and its clinical implications. Case report: A male patient had been followed since 2015 with rising Prostate-Specific Antigen (PSA) levels while using a 5-alpha-reductase inhibitor (5-ARI). Despite persistent suspicious findings on multi-parametric MRI (PI-RADS 4), five consecutive systematic biopsies yielded negative results. In December 2025, the sixth biopsy eventually identified acinar adenocarcinoma with a Gleason score of 3+3 (Grade Group 1). The patient subsequently underwent robot-assisted radical prostatectomy (RARP) in March 2026. Result: The final histopathological report from the surgical specimen revealed a significant grade shift to Gleason score 4+4 (Grade Group 4), featuring a combination of acinar and ductal adenocarcinoma. The tumor involved 35% of the prostate volume, was confined to the gland (pT2), and showed perineural invasion. Conclusion: This case highlights the critical need to adjust PSA interpretation during 5-ARI therapy and the clinical superiority of MRI-targeted biopsy over systematic sampling for PI-RADS ≥ 4 lesions. Furthermore, clinicians must remain vigilant regarding potential grade migration and aggressive histological variants like ductal adenocarcinoma, which may be underestimated in initial biopsies.