55b - Answer: 66-year-old male presents with PSA 2.07
HISTORY:
This 66-year-old male presents with PSA 2.07. Three biopsies, first was five years prior, and most currently one year prior. Positive for prostate cancer. Splenectomy 20 years ago. Vasectomy 37 years ago.
PRIMARY FINDING:
PI-RADS category 2 of 5.
FINDINGS:
Borderline prostatomegaly with glandular dimensions measuring 4.80 x 4.51 x 3.79cm for a volume of 53.7mL (bullet equation). No suspicious restricted diffusion in the prostate gland. No suspicious early arterial phase enhancement in the prostate gland. No suspicious washout enhancement kinetics in the prostate gland. No dominant nodule or suspicious T2 hypointensity in prostate gland. No invasion through anatomic capsule, surgical capsule, rectoprostatic angles, rectum, seminal vesicles or urinary bladder. Stromal and glandular hyperplasia mildly expand the prostatic central gland. Mild postinflammatory scarring in the prostatic peripheral zone. Seminal vesicles demonstrate normal and symmetric hydration.
Normal bladder wall thickness without suspicious intravesicular filling defect. Rectum normal wall thickness and mucosal pattern. No enlarged inguinal or intrapelvic lymph nodes. Small bilateral fat-filled inguinal hernias with moderate right-sided varicocele. Sigmoid colonic diverticulosis partially evaluated. Phleboliths in the right rectoprostatic venous structures.
No suspicious osseous lesion in the visualized axial or visualized appendicular skeleton.
CONCLUSION:
1. PI-RADS category 2 of 5, probable benign findings in the prostate gland. Findings are discordant with patient's reported positive biopsy results. Note lower grade gleason scores substantively less than 6 and intraprostatic epithelial neoplasia may have negative MRI.
a. Borderline prostatomegaly with glandular volume measuring 53.7mL for a very low PSA density measuring 0.0385.
b. No suspicious enhancement or restricted diffusion in the prostate gland. No invasion through anatomic capsule, rectoprostatic angles, surgical capsule, seminal vesicles, rectum or urinary bladder.
2. Small bilateral fat-filled inguinal hernias with moderate right-sided varicocele.
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Content reviewed: October 25, 2021