70b - Answer: 65-year-old male presents with elevated PSA
HISTORY:
This 65-year-old male presents with elevated PSA of 7.82ng/mL five months prior; 7.7ng/mL one year prior; 5.1ng/mL five years prior. Negative biopsy five years prior. Hernia surgery eight years prior.
PRIMARY FINDING:
PI-RADS 5.
FINDINGS:
The prostate measures 7.04 x 5.68 x 6.87cm. These measurements correspond to a volume of 142.85cc and a tumor density of 0.055ng/mL/cc which is just above normal range.
Peripheral Zone: Compressed. No lesion. PI-RADS 1.
Central zone/transitional zone: Heterogeneously enlarged with protrusion into the bladder trigone. Bladder wall thickening compatible with chronic outlet obstruction. No diffusion restriction.
Lesion #1: Mildly decreased T2 signal within a right paramedian central zone lesion with maximum diameter of 2.5cm. T2 Score 5.
DWI/ADC score: 3.
DCE: Positive.
Extraprostatic extension: None.
PI-RADS score 5.
Neurovascular bundles: Normal.
Seminal vesicles: Normal.
Adjacent organ involvement: None. Normal rectoprostatic angles.
Space of Retzius: Normal.
Lymphadenopathy: None.
Other findings: None.
CONCLUSION:
1. Right prostate mid to base CZ/TZ lesion with ill-defined margins, positive DCE, and mild diffusion restriction: PI-RADS 5.
2. Diffuse CZ/TZ hypertrophy with bladder wall thickening compatible with chronic outlet obstruction.
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Content reviewed: October 25, 2021