[Clinical Picture] Mixed acinar and macrocystic ductal prostatic adenocarcinoma

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A 64-year-old man with a prostate-specific antigen (PSA) of 5·74 ng/mL, no lower urinary symptoms, and a family history of prostate cancer presented at our clinic at University College London Hospital (London, UK) in April, 2018. Axial T2-weighted MRI of the prostate showed a multicystic lesion (PSA density 0·07 ng/mL/mL), and MRI-targeted biopsies showed Gleason 3 + 3 adenocarcinoma (Gleason Grade Group 1) with prostatic intraepithelial-like ductal features. The patient was offered either surgery or an MRI-led active surveillance pathway.

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