71b - Answer: 62-year-old male presents with elevated PSA of 37.1ng/mL
HISTORY:
This 62-year-old male presents with elevated PSA of 37.1ng/mL. Negative biopsy four years prior.
PRIMARY FINDING:
PI-RADS 5.
FINDINGS:
Prostate volume: The prostate measures 7.5 x 7.0 x 6.3 cm for an estimated volume, using the ellipsoid formula, of 173 cc.
PSA density: 0.214 NG/mL/CC.
Peripheral zone: No suspicious diffusion restricting T2 hypointensity.
Central zone: BPH. Protrusion into the bladder trigone.
Multiple areas of diffusion restriction:
1. 1.2 x 1.3 centimeters mid gland to apex left TZP. PI-RADS 4.
2. 1.4 x 1.3 centimeters mid gland to apex right TZP, PI-RADS 4.
3. 3.85 x 2.32 cm mid gland to apex left and right TZA with large area of capsular contact but no extracapsular extension, crossing the midline, PI-RADS 5.
Bladder: Wall thickening due to outlet obstruction.
Seminal vesicles: Normal.
Recto prostatic angles: Normal.
Space of Retzius: Normal.
Lymphadenopathy: None.
Bone lesions: None.
Other: Moderate right femoroacetabular capsulitis, acetabular spurring and fragmented spur along the right acetabular rim. Mild osteoarthropathy of the left hip.
CONCLUSION:
PI-RADS 5/5:
1. Large lesion in the left and right TZA without visible extracapsular extension, though large area of capsular contact typically corresponds to or correlates with microscopic extracapsular extension.
2. Smaller lesions in the right and left TZP without capsular contact.
3. BPH protruding into the bladder trigone. Bladder wall thickening compatible with outlet obstruction.
4. Femoroacetabular arthropathy and right capsulitis.
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Content reviewed: October 25, 2021