38b - Answer: 78-year-old male presents with elevated PSA level measuring 10.6 ng/mL
HISTORY:
This 78-year-old male presents with elevated PSA level measuring 10.6 ng/mL. History of positive biopsies three years and one year prior.
PRIMARY FINDING:
PI-RADS 4 of 5.
FINDINGS:
The prostate gland measures 4.5 cm in CC, 4 cm in AP and 5 cm in RL dimensions. Calculated prostate volume is 47 cc and PSA density 0.22 ng/mL/cc.
Transitional zone hyperplasia is present. No suspicious T2 hypointense area with substantive diffusion restriction in the transitional zone to suggest malignant neoplastic process. There is a 1 cm in diameter nodular hypointensity with substantive diffusion restriction and/or early arterial enhancement in the right mid segment posterior peripheral zone (PI-RADS 4 of 5). The lesion abuts the anatomical prostate capsule without substantive evidence of extracapsular extension. Micro invasion of the capsule is not excluded. Bilateral neurovascular bundles and dehydrated seminal vesicles appear clear.
Rectum wall and space of Retzius are clear.
Urinary bladder is partially full. Indentation of the enlarged transitional zone to urinary bladder floor is noted.
Slightly ectatic distal ureters measuring up to 0.7 cm in diameter. This finding is stable compared to prior study.
No lymphadenopathy in the pelvis or inguinal regions.
No free or loculated fluid collections.
Musculoskeletal structures are grossly normal. No abnormal osseous enhancement identified.
Small hydrocele is noted at the film edge, stable compared to prior study.
CONCLUSION:
1. PI-RADS 4 of 5, the lesion is in the right mid segment posterior peripheral zone, stable. Annual MR imaging surveillance is recommended given prior history of known cancer.
2. Slightly ectatic distal ureters measuring up to 0.7 cm in diameter. This finding is stable compared to prior study.
3. Small hydrocele seen at the film edge. Scrotal ultrasound examination is recommended if it has not been done yet.
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Content reviewed: October 25, 2021