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62b - Answer: 64-year-old male presents with elevated PSA of 5.1ng/mL

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

HISTORY: 

This 64-year-old male presents with elevated PSA of 5.1ng/mL. Biopsy one year prior.

PRIMARY FINDING: 

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.

FINDINGS

Prostate Volume: 2.9 x 4.1 x 3.9cm for an estimated volume, using the bullet formula, of 30cc.

PSA Density: 0.169 ng/mL/cc.

Peripheral Zone: No diffusion restricting T2 hypointensity.

Central Zone: Right midgland diffusion restricting T2 hypointense 1.3 x 1.4cm lesion in the TZa, with no bulging of the capsule or extracapsular extension and no invasion of the adjacent urinary bladder. BPH protruding into the bladder trigone slightly. Bladder wall thickening compatible with outlet obstruction.

Bladder: Wall thickening due to outlet obstruction.

Seminal Vesicles: Normal.

Rectoprostatic Angles: Normal.

Space of Retzius: Normal.

Lymphadenopathy:  None.

Bone Lesions: Nonenhancing well-marginated 5mm lesion left inferior pubic ramus. Symphysis pubis arthrosis. Fat-containing inguinal hernias without complication.

Other: None.

CONCLUSION:

1. PI-RADS 4/5.

2. Diffusion restricting and T2 hypointense right midgland TZa lesion measuring 1.3 x 1.4cm with weakly positive DCE but no extracapsular extension.

3. BPH and bladder wall thickening compatible with outlet obstruction.

4. Fatty inguinal hernias without complication.

5. Tiny bone lesion in the left ischium which is likely benign and incidental but should be followed given the patient's elevated PSA. Benign bone island favored.

6. Total left hip arthroplasty.

LESSON 4, TOPIC 36

Case Challenge: Prostate MRI Cases

Case Challenge

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Content reviewed: October 25, 2021

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