9b - Answer: 61-year-old male presents with elevated PSA
HISTORY:
This 61-year-old male presents with elevated PSA.
PRIMARY LOCATION OF HYPERTROPHY AND PROSTATIC ENLARGEMENT IN THIS CASE:
Median Lobe.
FINDINGS:
Non-prostate findings: L5-S1 degenerative spondylosis, biforaminal stenosis and disc desiccation. L4-5 disc desiccation.
Prostate: The prostate measures 4cm AP, 5cm transverse, and excluding the median lobe, 4cm craniocaudal. Median lobe hypertrophy at the bladder base.
Highlighted with arrows on multiple diffusion images and ADC maps is a small focal area of diffusion restriction and slight hypervascularity seen on the nonsubtracted dynamic images and also highlighted for your perusal and interest. Its size is less than 4 to 5mm, although nodular hypertrophy of the central zone is most prominent in this locus. The position would be categorized in the intermediate portion of the midsegment of the prostate on the patient's left (viewer's right) and just slightly below the prostate equator at approximately 4-o'clock.
Given the fact that hypervascularity is scant, the lesion is small, the degree of mass effect is nominal, and the lesion is isolated to the central zone a 6- to 12-month followup would be the next diagnostic algorithm of choice.
No signs of bone lesion, adenopathy, seminal vesicle obstruction, violation of the space of Retzius, violation of the Denonvilliers fascia, or abnormalities of the prostate apex are noted.
CONCLUSION:
1. Median lobe hypertrophy and mild prostatic enlargement for age with dimensions given in the body of the report.
2. Left-sided central zone focus of diffusion restriction and hyperintensity highlighted for your perusal and interest on multiple arrowed and marked images for which watchful waiting would be the next diagnostic algorithm of choice based on clinical review and the MR findings. The area of greatest interest remains in the central zone.
3. As described in the original report, diffuse hypointensity throughout the peripheral zone is more compatible with chronic prostatitis than neoplasm and no additional supportive signs which suggest malignancy in this region.
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Content reviewed: October 25, 2021