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20b - Answer: 63-year-old male presents with elevated PSA

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files


This 63-year-old male presents with elevated PSA.


PI-RADS 5/5.


The prostate measures 5.6 x 5.7 x 4.2cm for an estimated volume, using the ellipsoid formula, of 70cc. Gland volume based on the Proview Software is 76cc. 

Peripheral Zone: PI-RADS 5 T2 signal abnormality replacing much of the left PZPL and PZPM at the mid gland maximum diameter of 2.4cm with greater than 2cm of capsular contact, with retraction of the overlying capsule. The lesion approaches but does not seem to involve the left seminal vesicle and there is no visible involvement of the rectoprostatic angle, neurovascular bundle or extracapsular tissues. The diffusion score is 3 and the DCE is positive, overall score of 5. The right peripheral zone is clear. 

Central Gland: CZ/TZ hypertrophy protruding into the bladder trigone causing bladder wall thickening from outlet obstruction. Heterogeneous diffusion signal throughout the CZ/TZ, PI-RADS 3 throughout. 

No lymphadenopathy or bone lesion. 

Normal space of Retzius. 

Normal seminal vesicles. 

Moderate capsulitis of the right hip joint. Small scrotal hydroceles. Bilateral hamstring origin tendinosis, greater on the left. 


1. PI-RADS 5/5: 

a. PI-RADS 5 lesion within the left mid gland PZPL and PZPM abutting but not visibility extending beyond the capsule. Greater than 2cm of capsular contact typically correlates with microscopic extracapsular extension. 

b. BPH and heterogeneous diffusion signal throughout the central and transitional zones, PI-RADS 3 throughout the CZ/TZ. 

c. Bladder wall thickening compatible with outlet obstruction. 

d. Small scrotal hydroceles.


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Content reviewed: October 25, 2021

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