PI-RADS 3 Prostate Lesion Masks Gleason 10 Disease Presenting With Cervical Skip Mets and Central Venous Thrombosis

A single case report: high-grade prostate adenocarcinoma (Gleason 5+5=10) debuted with cervical lymph node skip metastases and extensive central venous thrombosis — no pelvic or bone involvement — despite only a PI-RADS 3 mpMRI lesion. Unexplained thrombosis in elderly men shoul…

• Single case report (n=1); design limits generalizability, but illustrates a recognized diagnostic pitfall in mpMRI risk stratification.
• PI-RADS 3 lesions carry intermediate malignancy risk and are not reliably reassuring — this case underscores that even low-intermediate mpMRI scores can harbor Gleason Grade Group 5 disease.
• Key limitation: anecdotal evidence only; no comparator group, no outcome data, and causality between imaging findings and disease biology cannot be established from a case report.

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