23b - Answer: 77-year-old male presents with elevated PSA level
HISTORY:
This 77-year-old male presents with elevated PSA level measuring 7.33ng/mL.
PRIMARY FINDING:
PI-RADS IV.
FINDINGS:
The prostate gland measures 3.8cm in CC, 4cm in RL and 2.8cm in AP dimensions. Calculated prostate volume is 28cc and PSA density is 0.26. Mild transitional zone hyperplasia is present. A 1.5cm x 1.3cm T2 hypointense mass with severe diffusion restriction and early arterial enhancement is present at the anterior peripheral zone of the apex, involving both sides. The lesion abuts and causes bulging of the anatomical prostate capsule without substantive evidence of extracapsular extension. Involvement of the transitional zone is also noted. Bilateral neurovascular bundles and seminal vesicles are clear.
Rectal wall and rectal prostatic angles are normal.
Urinary bladder is not completely full. No focal wall thickening or diverticular formation identified.
No lymphadenopathy in the pelvis.
No abnormal osseous enhancement identified. Mild capsulitis of bilateral hip joints. Intraosseous ganglion formation is noted at the posterior inferior nonweightbearing surface of the right femoral head.
CONCLUSION:
PI-RADS 4/5, the dominant lesion is in the anterior peripheral zone of the apex, which also involves the transitional zone. No extracapsular extension.
Case Challenge: Prostate MRI Cases
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Content reviewed: October 25, 2021