64b - Answer: 69-year-old male presents with elevated prostate specific antigen
HISTORY:
This 69-year-old male presents with elevated prostate specific antigen (15ng/mL).
PRIMARY FINDING:
PI-RADS 4.
FINDINGS:
Transitional zone of the prostate gland demonstrates hyperplasia with multiple hypo- and hyperintense regions. The prostate measures 6cm in CC, 4.2cm in AP, and 5cm in RL dimensions. Prostate volume is 66cc. PSAD is 0.22. Hypertrophic median lobe of the prostate gland demonstrates indentation to the bladder floor. An area measuring 1.6cm x 1cm with T2 hypointensity, diffusion restriction, and hypervascularity is noted at the right basal hypertrophic transitional zone and considered as PI-RADS 4. Suspect > Gleason 6. Two other areas of T2 hypointensity and diffusion restriction are evident in the right mid-apical peripheral zone and left mid-apical peripheral zone measuring 1.2cm x 0.7cm and 1cm x 0.9cm, respectively (PI-RADS 3). No substantive evidence of capsular invasion. Neurovascular bundles and seminal vesicles appear unremarkable. Focal areas of T1 hyperintensities are noted in the transitional zone of the prostate gland most likely representing mucoid material within the hyperplastic glands.
Small-field-of-view images of the pelvis did not reveal any enlarged lymph nodes. No free or loculated fluid collections. Diffuse mild-to-moderate wall thickening of the urinary bladder is noted.
Bone marrow signal intensity and musculature are normal.
Surgical clips in the left inguinal region, suggestive of inguinal hernia repair.
CONCLUSION:
1. An area measuring 1.6cm x 1cm with T2 hypointensity, diffusion restriction, and hypervascularity at the right basal hypertrophic transitional zone and considered as PI-RADS 4 (right basal TZp). Suspect > Gleason 6.
2. Two areas of T2 hypointensity with mild diffusion restriction in the right mid-apical peripheral zone (PZp) and left mid-apical peripheral zone (PZp) measuring 1.2cm x 0.7cm and 1cm x 0.9cm, respectively (PI-RADS 3).
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Content reviewed: October 25, 2021