67b - Answer: 61-year-old male presents with elevated PSA level
HISTORY:
This 61-year-old male presents with elevated PSA level. PSA measures 16ng/mL. Three biopsies, most recent six months ago. Enlarged prostate gland. No cancer detected.
PRIMARY FINDING:
PI-RADS 2 of 5.
FINDINGS:
Enlarged prostate gland measures 5.27cm TV x 4.77cm CC x 2.90cm AP for a volume of 37.9mL. PSA density calculated at 0.42 (marked elevation). Heterogeneity in the prostatic central zone compatible with benign prostatic hyperplasia. A 3.5mm prostatic utricle cyst seen adjacent to the prostatic urethra. A 1.9 x 0.9 x 0.6cm T2 hypointense nodule resides centrally within the prostatic gland anterior fibromuscular stroma. Persistent DWI hyperintensity noted that persists to high B-values. Persistent ADC hypointensity persists at high B-values. 7mm hypointense thickening of the anterior fibromuscular stroma, which remains symmetric. No transgression/invasion through the prostatic anatomic or surgical capsules. Rectoprostatic angles clear. Perirectal fat planes clear. Periprostatic fat clear. No invasion of bladder. Linear T2 hypointense band suggesting prior inflammation/infection seen in the peripheral zones, more pronounced on the right.
No enlarged inguinal or intrapelvic lymph node. No suspicious osseous lesion in the visualized axial or proximal appendicular skeleton. Partially distended urinary bladder demonstrates circumferential bladder wall thickening ranging from 4-8mm. No free fluid in pelvis. No substantive scrotal hydrocele. Left varicocele. Visualized external genitalia intact.
A 6mm cyst projects anteroinferiorly from the right hip joint capsule. No acute osseous abnormality.
CONCLUSION:
1. PI-RADS 2 of 5, probably benign 1.9cm T2 hypointense nodule in the anterior mid gland at the junction of the anterior fibromuscular stroma and the anterior transition zone. Finding demonstrates type 1/normal enhancement kinetic similar to background central zones, however, has persistent restricted diffusion at high B-values. Request one-year followup.
2. Marked, symmetric thickening of the anterior fibromuscular stroma can also be re-assessed at 1 year followup.
3. Incidental note of tiny prostatic utricle cyst. Left varicocele.
4. No suspicious inguinal or intrapelvic lymphadenopathy. No suspicious osseous lesion in the visualized axial or proximal appendicular skeleton. No invasion of the rectum, rectoprostatic angles, seminal vesicles or the urinary bladder.
5. Prostatomegaly with evidence of benign prostatic hyperplasia and scarring in the prostatic peripheral zone. Prostatic volume measures 37.9mL, PSA density is 0.42 (high risk range).
6. Circumferential bladder wall thickening ranging from 4-8mm. Findings can be correlated for any BPH-lower urinary tract symptomatology.
7. 6mm cyst projects anteroinferiorly from the right hip joint capsule. Differential considerations include capsular cyst, ganglion cyst, paralabral pseudocyst (in the setting of an anteroinferior labral tear) with injury to the transverse acetabular ligament a less likely consideration.
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Content reviewed: October 25, 2021