Fig. 5.

A 56-year-old man with cT2a, Gleason score 4 + 4 = 8 prostate cancer (PCa) and an initial PSA 54 ng/mL considered candidate for radical prostatectomy with extended pelvic lymph-node dissection. MSKCC nomogram showed 77.9% risk of lymph-node involvement. Transversal ¹⁸F-DCFPyL PET (a) and fused PET/CT images (b) revealed two foci with high PSMA expression dorsal from the urinary bladder, left and right, corresponding with bilateral seminal vesicle involvement (all arrows) on the CT (c). No suspicion of metastasized PCa was found using ¹⁸F-DCFPyL PET/CT. The primary tumour was located bilaterally in the base and midglandular regions of the prostate confirming the findings. Histopathological analysis showed a bilateral pT3b, Gleason score 4 + 5 = 9 PCa in the radical prostatectomy specimen, haematoxylin and eosin stain, original magnification × 5 (d). No lymph-node metastases were found after histopathological analysis of 15 resected lymph nodes