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MRI Online

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47b - Answer: 75-year-old male presents with prostate neoplasm

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files


This 75-year-old male presents with prostate neoplasm, PSA of 28.69. Diagnosed with cancer five years ago, active surveillance.


PI-RADS 4/5.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


The prostate measures 4.2 x 2.9 x 5.8cm for an estimated volume, using the bullet formula, of 46cc and tumor density of 0.625ng/mL/cc which is in the high risk range.  

Peripheral Zone: Right apex PZa and PZpl weak T2 hypointensity, ill defined 2.5 x 1.3 cm, without capsular contact greater, located deep within the peripheral zone, PI-RADS 3-4 for the T2 signal. The diffusion signal corresponds to PI-RADS 4 and the DCE is positive therefore overall score is 4. 

Heterogeneous signal throughout the remainder of the peripheral zone. T2 hypointense region of weak diffusion restriction within the left PZpl mid gland, PI-RADS 2. Weakly positive DCE at this location. 

Central Gland: Crossing the midline is a multilobulated area of mixed T2 signal, measuring 3.1 x 2.6cm image 9 of series 7, the T2 score is 2, but the diffusion score is 4 and the DCE is positive overall score of 4. This lesion is located in the paramedian TZa and possibly the AS and has greater than 1cm of capsular contact but no visible extracapsular extension or invasion of the adjacent bladder base.  

The seminal vesicles are normal. 

The rectoprostatic angles and neurovascular bundles are normal. 

The space of Retzius is normal. 

Small right hip effusion. 

No lymphadenopathy or bone lesion. 

Moderate left greater than right hamstring origin tendinosis without macrotear. 


1. PI-RADS 4/5. 

a. Lesion in the prostate base TZa, crossing the midline, possibly involving the AS and measuring 3.1 x 2.6cm, PI-RADS 4. This lesion has greater than 1cm of capsular contact which typically correlates with microscopic extracapsular distention. However, there is no visible extracapsular extension on this exam. No involvement of the bladder base.

b. PI-RADS 4 lesion right apex PZa and PZpl measuring 2.5 x 1.3 cm, without extracapsular extension or capsular contact. 

c. BPH protruding into the bladder and trigone resulting in bladder wall thickening as a result of outlet obstruction. 

d. No lymphadenopathy or bone lesion.


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Content reviewed: October 25, 2021

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