6b - Answer: 65-year-old male presents with an elevated PSA
HISTORY:
This 65-year-old male presents with an elevated PSA of 12.27. Negative biopsy without cancer diagnosis.
PRIMARY FINDING:
PI-RADS V.
FINDINGS:
The prostate measures 4.2 x 4.3 x 5.1cm for an estimated volume, using the bullet formula, of 59.8cc and a tumor density of 0.205 ng/mL/cc which is in the high risk range.
Peripheral Zone: Diffuse and restricting vascular 3.8 x 3.5 x 4.2cm T2 hypointense mass involving the right PZpl, PZpm; bulging the right side of the capsule, impinges upon the right neurovascular bundle and narrows the right rectoprostatic space. In addition, this mass invades the abnormal right seminal vesicle. The mass involves the entire right PZpl and PZpm from apex to base. PI-RADS 5 for this lesion.
No left-sided peripheral zone lesion. The above mass does not seem to cross the midline in the peripheral zone but may cross the midline in the central gland. The left seminal vesicle is normal.
The left rectoprostatic angle and neurovascular bundle are normal.
The space of Retzius is normal.
Suspicious bone lesions in the right pubis and in the left acetabulum.
Colonic diverticulosis.
No lymphadenopathy.
Mild SI joint arthrosis.
Iliopsoas peritendinitis and bursitis of the right hip.
CZ/TZ hypertrophy and bladder wall thickening compatible with outlet obstruction. No additional lesions in the CZ or TZ.
CONCLUSION:
PI-RADS 5/5:
a. Dominant lesion in the right PZpl and PZpm, from apex to base, bulging the capsule, and likely involving the right neurovascular bundle. This lesion invades the seminal vesicle and measures 3.8 x 3.5 x 4.2cm, T3b.
b. Suspicious bone lesions in the right pubis and left acetabulum.
c. BPH and bladder wall thickening compatible with outlet obstruction.
d. Colonic diverticulosis.
e. Right iliopsoas peritendinitis and bursitis.
Case Challenge: Prostate MRI Cases
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Content reviewed: October 25, 2021