40b - Answer: 72-year-old male presents with elevated PSA, biopsy two years ago
HISTORY:
This 72-year-old male presents with elevated PSA, biopsy two years ago. Lung cancer.
PRIMARY FINDING:
PI-RADS 3 of 5.
FINDINGS:
The prostate measures 7.6 x 6.0 x 7.1cm for an estimated volume, using the ellipsoid formula, of 169.4cc and tumor density of 0.062 ng/mL/cc which is at the lower end of the indeterminate risk range.
Peripheral Zone: Bilobed diffusion restricting signal abnormality within the right midgland PZpa measuring 1.7 x 1.0cm with greater than a centimeter of capsular contact but no extracapsular extension. There is vascularity in this region but no corresponding T2 signal abnormality. PI-RADS 3.
Central Gland: Bilobed 10 x 7mm lesion in the central gland TZp midprostate near the midline and a second area in the lateral aspect of the left midgland TZp on the same key image, this lateral lesion measuring 9 x 5mm. The vascularity is equivocal. No corresponding T2 lesion.
Normal rectoprostatic angles and neurovascular bundles.
The left seminal vesicle is desiccated. The right is normal.
Normal space of Retzius.
Prostatomegaly protruding into the bladder trigone. Bladder wall thickening compatible with outlet obstruction.
No lymphadenopathy or bone lesion.
CONCLUSION:
1. PI-RADS 3 of 5.
a. Multiple areas of diffusion restriction within the prostate, as above, three lesions identified, though none of which have suspicious T2 correlates.
b. BPH and bladder outlet obstruction.
c. No lymphadenopathy or bone lesion.
Case Challenge: Prostate MRI Cases
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Content reviewed: October 25, 2021