41b - Answer: 64-year-old male presents with increasing PSA following negative biopsy
HISTORY:
This 64-year-old male presents with increasing PSA following negative biopsy. PSA has increased from 5.07 ng/mL to 9 ng/mL in seven months.
PRIMARY FINDING:
PI-RADS 4/5.
FINDINGS:
The prostate measures 3.5 x 3.5 x 4.6cm for an estimated volume, using the bullet formula, of 37cc and tumor density of 0.246ng/mL/cc which is in the high risk range.
Peripheral Zone: Diffusion restricting crescent T2 hypointensity in the left base measuring 1.0 x 0.6cm involving the entrance of the left seminal vesicle. No right-sided lesion in the peripheral zone.
Prostate utricle cyst.
Central Gland: CZ/TZ hypertrophy with bladder wall thickening compatible with outlet obstruction. Innumerable T2 hypointensities and patchy areas of diffusion restriction, too numerous to count, favored to reflect hyperplastic nodules without suspicious lesion.
Heterogeneous vascularity throughout the prostate.
No lymphadenopathy or bone lesion.
Colonic diverticulosis.
Mild symphysis pubis arthrosis.
Normal space of Retzius.
Normal rectoprostatic angles.
CONCLUSION:
1. PI-RADS 4/5:
a. Left base lesion in the PZpm with diffusion restriction, T2 hypointensity and possible seminal vesicle involvement, which would make this a T3b lesion. No visible extracapsular extension.
b. BPH and bladder outlet obstruction. Heterogeneous signal throughout the central gland without suspicious focus.
c. Incidental prostate utricle cyst.
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Content reviewed: October 25, 2021