53b - Answer: 76-year-old male presents with elevated prostate specific antigen
HISTORY:
This 76-year-old male presents with elevated prostate specific antigen, which measures 37.84ng/mL. History of three prostate biopsies, which were negative.
PRIMARY FINDING:
PI-RADS 5.
FINDINGS:
The prostate measures 5cm in CC, 4.8cm in RL, and 4.2cm in AP dimension. The prostate volume measures 66cc. PSA density of 0.57.
A 4.2cm x 2.4cm x 2.3cm ill-defined T2 hypointensity with substantive diffusion restriction is present at the right transitional zone, mostly in the anterior aspect. The lesion abuts the anatomical prostate capsule, extends into peripheral zone on the right and indents the urinary bladder floor. Wall invasion cannot be excluded. Bilateral neurovascular bundles are intact. No substantive seminal vesicle involvement seen.
No enlarged lymph nodes in the pelvis or inguinal regions. A lipoma measuring 4cm x 3.5cm is noted at the right lateral aspect of the rectum. The lipoma indents the rectum from right lateral aspect. No thick septations or solid components concerning for malignant process.
Small fat-containing inguinal hernias are noted.
Visualized osseous structures demonstrate normal intensity. Moderate osteoarthrosis of the symphysis pubis is noted. Musculature and tendons are unremarkable.
CONCLUSION:
1. PI-RADS 5, 4.2cm x 2.4cm x 2.3cm ill-defined T2 hypointense, diffusion-restrictive lesion involving most of the right transitional zone, abutting the anatomic capsule and indenting the urinary bladder floor. Anatomic capsular invasion and bladder invasion cannot be excluded.
2. A 4cm x 3.5cm right pararectal lipoma without malignant features.
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Content reviewed: October 25, 2021