72b - Answer: 74-year-old male presents with prostate neoplasm
HISTORY:
This 74-year-old male presents with prostate neoplasm diagnosed 3-4 years ago, active surveillance. PSA 9.6ng/mL.
PRIMARY FINDING:
PI-RADS 4/5.
FINDINGS:
The prostate measures 5.8 x 3.5 x 5.1cm for an estimated volume, using the ellipsoid formula, of 54cc. The bullet formula estimates a volume at 67cc.
The tumor density is between 0.143 and 0.177ng/mL/cc, both of which are in the high risk range.
Peripheral Zone: T2 hypointense ill-defined nodule right mid gland to apex PZpm, measuring maximum 6.7mm with less than 1cm of capsular contact but no extracapsular extension. The T2 score is 3, the diffusion score is 4, the DCE is positive. Overall score 4. On the same image, an area of decreased T2 signal, with less than 1 cm of capsular contact, 7.8mm in maximum diameter, and weak if any diffusion restriction, PI-RADS 3. The DCE is positive. The background signal at the peripheral zone is heterogeneously decreased.
Central Gland: CZ/TZ hypertrophy protruding into the bladder trigone. Bladder wall thickening compatible with outlet obstruction.
Diffusion restricting 1.1cm lesion right paramedian TZa near the base, diffusion score 4, T2 score of 3, positive DCE, overall score 4.
Normal seminal vesicles.
Normal rectoprostatic angles.
Normal spacer of Retzius.
Normal lymphadenopathy or bone lesion.
Mild hamstring origin tendinosis. Mild bilateral gluteus medius and minimus peritendinitis and tendinosis.
CONCLUSION:
1. PI-RADS 4/5.
a. PI-RADS 4 lesion right mid gland PZpm measuring 6.7mm with less than 1cm of capsular contact but no extracapsular extension.
b. PI-RADS 3 lesion left PZpm with less than 1cm of capsular contact and no extracapsular extension.
c. PI-RADS 4 lesion right base TZa measuring 1.1cm.
2. BPH and bladder wall thickening compatible with outlet obstruction.
Case Challenge: Prostate MRI Cases
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Content reviewed: October 25, 2021