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27b - Answer: 58-year-old male presents with malignant neoplasm of the prostate

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

HISTORY: 

This 58-year-old male presents with malignant neoplasm of the prostate. PSA of 4.9. Biopsy and one of 12 samples came back positive for prostate cancer.

PRIMARY FINDING: 

PiRADS 5/5.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

The prostate measures 4.2 x 3.4 x 5.0cm for an estimated volume, using the bullet formula, of 46cc and tumor density of 0.101ng/mL/cc which is in the indeterminate risk range. 

Peripheral Zone: No diffusion restricting suspicious T2 hypointensity within the peripheral zone. Slightly heterogeneous signal within the peripheral zone may be from prior inflammation or scarring/surgery. 

Central Gland: Left mid gland to apex T2 hypointense diffusion restricting hypervascular lesion measuring 2.0 x 1.1 x 1.9cm with greater than 1cm of capsular contact which typically correlates with microscopic extracapsular contact. However, normal space of Retzius. 

The remainder of the CZ/TZ is heterogeneous. Bladder wall thickening suggests bladder outlet obstruction. 

Normal seminal vesicles and rectoprostatic angles. Normal neurovascular bundles. 

Colonic diverticulosis. 

No lymphadenopathy or bone lesion. Mild left greater than right hamstring origin tendinosis without macrotear. Small bilateral hip effusions and mild capsulitis. Visualized vasculature is normal. 

CONCLUSION

1. PiRADS 5/5. 

a. Lesion in the left mid gland base TZa with greater than 1cm of capsular contact, the lesion itself measuring 2.0 x 1.1 x 1.9cm. 

b. No suspicious peripheral zone lesion. 

c. BPH related to bladder wall thickening from outlet obstruction. 

d. Normal space of Retzius. No lymphadenopathy or bone lesion.

LESSON 3, TOPIC 6

Case Challenge: Prostate MRI Cases

Case Challenge

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Content reviewed: October 25, 2021

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