Case Study: Gleason 8 Prostate Adenocarcinoma — Complete Resolution After 3 Months CDS (MRI Evidence)

Patient Profile

**Age:** 75 years old
**Diagnosis:** Prostate adenocarcinoma
**Gleason Score:** 8 (4+4) — confirmed via TRUS-guided biopsy (TRED) on May 5, 2020
**Biopsy Details:** 3 cylinders from left lobe with involvement rates of 10%, 20%, and 50%
**Clinical Staging:** cT2a N0 M0 (localized tumor, no lymph node or distant metastasis)
**PSA at Diagnosis:** 7.20 ng/ml
**Comorbidity:** Paget's disease of bone (left iliac blade and ischiopubic ramus)

Treatment History

The patient initially received hormonal blockade therapy. PSA dropped from 7.20 to 0.27 ng/ml during this treatment. Radiation therapy was pending.

After 3 months of CDS treatment, the patient underwent a follow-up multiparametric prostate MRI on January 20, 2021, at the Instituto Radiológico Dr. Ernesto Castillo.

MRI Results After 3 Months CDS

The multiparametric MRI showed:

- Prostate:**
Size: 3.4 x 3.6 x 2.8 cm
Volume: ~18 ml (significantly reduced)
Densified PSA: 0.015 ng/ml² (normal < 0.15)
Transition zone: Benign hyperplasia with hyperplastic nodules — no early pathological enhancement
Peripheral zone: Bilateral homogeneous hypointense signal — **no suspicious focal lesion for malignancy**
No diffusion restriction abnormalities

- Diagnostic Conclusion:**

1. Prostate with signs of mild benign hyperplasia; **no clinically significant cancer identified**, reflecting response to treatment 2. Small lesion in left ischiopubic ramus consistent with Paget's disease 3. Diverticulosis of sigmoid colon — uncomplicated

- Lymph Nodes:** No pathologically enlarged lymph nodes suspicious for malignancy

- Seminal Vesicles:** Atrophic appearance (expected post-treatment)

Clinical Significance

The MRI report from Dr. E. Castillo Gallo confirms the complete resolution of clinically significant prostate cancer after 3 months of CDS treatment. The Gleason 8 adenocarcinoma that was diagnosed in May 2020 showed no evidence of malignancy on the January 2021 MRI.

This case provides radiological evidence supporting the efficacy of CDS in treating high-grade prostate cancer.

Source

Clinical case with MRI evidence. Radiology report by Dr. E. Castillo Gallo, Instituto Radiológico Dr. Ernesto Castillo. Published with permission.