25b - Answer: 82-year-old male presents with malignant neoplasm of the prostate
HISTORY:
This 82-year-old male presents with malignant neoplasm of the prostate, elevated PSA, testicular hypofunction. PSA of 4.63. Positive biopsy six months ago. Previous TURP.
PRIMARY FINDING:
PI-RADS IV.
FINDINGS:
The prostate measures 3.9 x 3.0 x 4.8cm for an estimated volume, using the bullet formula, of 36.5cc and tumor density of 0.127 ng/mL/cc which is in the lower end of the high risk range. Using the ProFuse software, the volume of the prostrate is estimated at 22.4cc.
Central zone defect compatible with TURP. Bladder wall thickening compatible with previous outlet obstruction. Heterogeneous signal throughout the central zone of the prostate compatible with BPH.
Peripheral Zone: Right mid gland PZpl and PZpm diffusion restricting T2 hypointensity measuring 1.4 x 1.4 x 1.5cm with positive vascularity but no extracapsular extension.
Normal rectoprostatic angles. Normal neurovascular bundles. Normal space of Retzius.
Effusion and capsular distention of the right greater than left hip joints. Fatty inguinal hernias.
No lymphadenopathy or bone lesion.
CONCLUSION:
PI-RADS 4 of 5.
a. Right mid gland PZpl/PZpm lesion measuring 1.4 x 1.4 x 1.5cm without extracapsular extension, though capsular content greater than 1cm typically correlates with microscopic extracapsular extension.
b. BPH status post TURP.
c. No lymphadenopathy or bone lesion.
d. Bilateral hip effusions.
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Content reviewed: October 25, 2021