63b - Answer: 67-year-old male presents with elevated PSA level
HISTORY:
This 67-year-old male presents with elevated PSA level which measured 6.89ng/mL four months prior. History of negative biopsy 13 years prior. No history of surgery.
PRIMARY FINDING:
PI-RADS 5.
FINDINGS:
The prostate gland measures 4.5cm in CC, 5cm in RL, and 4.3cm in AP dimensions. Calculated prostate volume is 63cc and PSA density is 0.11.
The transitional zone of the prostate gland demonstrates hyperplasia. No suspicious area of T2 hypointensity with diffusion restriction in the transitional or peripheral zone of the prostate gland to suggest neoplastic process. T2 hypointense region measuring larger than 2cm x 1.5cm with diffusion restriction is present at the anterior aspect of the prostate gland corresponding to anterior fibromuscular stroma. Linear and nodular areas of T1 and T2 hyperintensity are noted in the surgical capsule posterior aspect suggestive of tiny calcifications. There is also thickening of the surgical capsule, likely secondary to prior biopsy. Anatomical capsule of the prostate gland appears intact. Bilateral neurovascular bundles are unremarkable. Fluid-fluid level is noted in the seminal vesicles suggestive of blood products. T1 hyperintense, T2 hypointense appearance in the left seminal vesicle is also likely secondary to subacute blood products.
No enlarged lymph nodes in the pelvis or inguinal regions. No free or loculated fluid collections. No abnormal enhancement in the visualized osseous structures.
Colonic diverticulosis is suspected on the localizer images.
CONCLUSION:
1. PI-RADS 5, T2 hypointense region measuring larger than 2cm x 1.5cm with diffusion restriction is present at the anterior aspect of the prostate gland corresponding to anterior fibromuscular stroma.
2. Suspected colonic diverticulosis.
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Content reviewed: October 25, 2021