45b - Answer: 83-year-old male presents with elevated PSA level measuring 15.7ng/mL
HISTORY:
This 83-year-old male presents with elevated PSA level measuring 15.7ng/mL. No family history of prostate cancer. Patient was diagnosed with prostate cancer seven years prior and under active surveillance.
PRIMARY FINDING:
PI-RADS 5 of 5.
FINDINGS:
Prostate gland measures 6.5cm in CC, 5.1cm in AP and 6cm in RL dimensions. Calculated prostate volume is 104 and PSA density is 0.15.
Transitional zone hyperplasia is present. Crescentic-shaped T2 hyperintensity measuring 1.9cm in longest dimension is present in the apical transitional zone asymmetric to the right. The lesion demonstrates severe diffusion restriction and early arterial enhancement. Abutment of the anterior capsule with bulging is noted. However, there is no substantive evidence of extracapsular extension. The lesion also abuts the distal prostatic urethra without evidence of wall invasion. Bilateral neurovascular bundles are intact. Generalized T2 hypointensities without mass-like appearance are seen in the peripheral zone. No substantive diffusion restriction or early arterial enhancement on washout to suggest malignant neoplastic process identified.
No enlarged lymph nodes in the obturator regions. No lymphadenopathy in the inguinal regions. A few reactive lymph nodes smaller than 1cm in short axis are noted.
Urinary bladder is full and demonstrates increased trabeculation and a pseudodiverticular formation at the right posterolateral and left lateral aspect.
Rectoprostatic angles are clear.
Bilateral fat-containing inguinal hernias are present.
Moderate degenerative arthritic changes of bilateral hip joints with mild capsulitis. Symphysis pubis is intact. Intrasubstance microtears are seen in the right hamstring origin. The left hamstring origin is intact.
CONCLUSION:
1. PI-RADS 5 of 5, the dominant lesion is in the transitional zone of the apex, asymmetric to the right. Bulging of the anatomical capsule. Extracapsular microinvasion is not excluded. Abutment of the distal prostatic urethra.
2. Urinary bladder is full and demonstrates increased trabeculation and a pseudodiverticula formation at the right posterolateral and left lateral aspect.
3. Fat-containing small inguinal hernias.
4. Moderate degenerative arthritic changes of bilateral hip joints with mild capsulitis.
5. Intrasubstance microtears of the right hamstring origin.
Case Challenge: Prostate MRI Cases
Case Challenge
Browse other topics in...
Content reviewed: October 25, 2021