69b - Answer: 77-year-old male presents with cancer diagnosis
HISTORY:
This 77-year-old male presents with cancer diagnosis by biopsy two years prior. On active surveillance. PSA 5.95ng/mL.
PRIMARY FINDING:
PI-RADS 5/5.
FINDINGS:
The prostate measures 5.0 x 3.7 x 4.5cm for an estimated volume, using the bullet formula, of 54cc and tumor density of 0.110ng/mL/cc.
Peripheral Zone: Ill-defined T2 hypointensity within the right PZpl measuring 2.1 x 1.0 x 1.6cm with greater than 1.5 x 2.0cm of capsular contact with no visible extracapsular extension. T2 score of 5 given the size, diffusion score of 5, and positive DCE.
Central Gland: CZ/TZ hypertrophy. The median lobe of the prostate protrudes into the lateral trigone. Bladder wall thickening compatible with outlet obstruction. No suspicious diffusion-restricting hypointensity or focal hypervascularity.
No lymphadenopathy of bone lesion.
No hernia.
Colonic diverticulosis.
Mild tendinosis and peritendinitis of bilateral gluteus medius and minimus insertions and hamstring origins.
Normal seminal vesicles.
CONCLUSION:
1. PI-RADS 5/5.
a. Right mid gland 2.1 x 1.0 x 1.6cm diffusion-restricting T2 hypointense vascular lesion in the PZpl with broad capsular contact, greater than 1.5 x 2.0cm, without visible extracapsular extension (although greater than 1cm of capsular contact typically correlates with microscopic extracapsular extension). PI-RADS 5.
2. BPH an bladder wall thickening compatible with outlet obstruction.
3. No lymphadenopathy or bone lesion.
Case Challenge: Prostate MRI Cases
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Content reviewed: October 25, 2021