73b - Answer: 58-year-old male presents with malignant prostate cancer
HISTORY:
This 58-year-old male presents with malignant prostate cancer diagnosed by biopsy three months prior. No surgery. PSA 5.8.
MOST PREVALENT ZONE IN WHICH PI-RADS III AND IV ARE LOCATED:
Peripheral Zone (PZ)
FINDINGS:
Morphology:
The prostate measures 4.5 cm transverse, 3.2 cm AP and 3.7 cm craniocaudal. The prolate ellipsoid volume is 28 ml. The PSA density is 0.21 ng/mL per cc.
Peripheral zone:
Suspicious 9 mm markedly diffusion restricting and mildly enhancing lesion in the right mid gland posteromedially (PZpm). PI-RADS 4.
Indeterminate 8 mm moderately diffusion restricting nonenhancing lesion in the right peripheral zone anteriorly (PZa) in the base. PI-RADS 3.
Suspicious 6 mm markedly diffusion restricting and markedly enhancing lesion in the left apical peripheral zone anteriorly (PZa). PI-RADS 4.
Indeterminate 5 mm left moderately diffusion restricting and nonenhancing lesion in the left peripheral zone posterolateral (PZpl). PI-RADS 3.
Transition zone:
Suspicious lesions. Small benign prostatic hyperplasia nodules.
Other:
Normal seminal vesicles and neurovascular bundle. No suspicious soft tissue or bony lesions.
Normal pre-prostatic space of Retzius.
Bilateral femoral head avascular necrosis larger on the left. Oval 14 x 8 mm well-defined hyperdense T1 lesion superior to the right acetabulum which may represent a paralabral cyst.
Mild uncomplicated colonic diverticulosis. No suspicious soft tissue or bony lesions.
CONCLUSION:
1. Two PI-RADS 4 lesions in the right and left peripheral zones as described.
2. Two PI-RADS 3 lesions in the right and left peripheral zones as described. These lesions are likely to represent prostate carcinoma but the lack of conspicuous signal may be due to oncological treatment. See montage.
Case Challenge: Prostate MRI Cases
Case Challenge
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Content reviewed: October 25, 2021