37b - Answer: 62-year-old male presents with elevated PSA level
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 5.
FINDINGS:
The prostate gland measures 4.6cm in CC, 3.3cm in AP and 4.5cm in RL dimensions. Calculated prostate volume is 45cc and PSA density is 1.2. T2 hypointense area with ill-defined contours and moderate to severe diffusion restriction is seen in the anterior transitional zone of both basal through apical segments measuring up to 3.7cm in long axis. The lesion abuts the anatomical prostate capsule without substantive evidence of extracapsular extension. Non-mass-like T2 hypointense areas within the peripheral zone likely associated with scarring. Bilateral neurovascular bundles and seminal vesicles appear clear.
External iliac lymph nodes measuring up to 0.9cm in short axis are seen bilaterally. No abnormal osseous enhancement. Mild capsulitis of bilateral hip joints.
Rectal wall and rectal prostatic angles are clear.
Right hydrocele is noted at the film edge.
CONCLUSION:
1. PI-RADS 5, lesion involves anterior transitional zone of base through apex bilaterally.
2. Prominent lymph nodes in bilateral external iliac chains measuring up to 0.8cm in short axis.
3. Right hydrocele. Ultrasound investigation is recommended.
Case Challenge: Prostate MRI Cases
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Content reviewed: October 25, 2021