3b (Prostate) - Answer: 80-year-old male presents with malignant neoplasm of prostate

HISTORY: 

This 80-year-old male presents with malignant neoplasm of prostate. PSA level measuring 9.37ng/mL.


(QUIZ ANSWER) PRIMARY FINDING: 

PI-RADS IV (Potentially PI-RADS V).


Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


FINDINGS:

Prostate gland measures 5cm in CC, 5.8cm in RL and 4cm in AP dimensions. Calculated prostate volume is 61cc and PSA density is 0.15. 

Transitional zone hyperplasia is present. A 1cm by 1.2cm T2 hypointensity with grade 5 diffusion restriction is seen at the left basal segment posterior peripheral zone, which also represents early arterial enhancement (PI-RADS 4). The lesion abuts the prostate capsule without substantive evidence of extracapsular invasion. No substantive evidence of seminal vesicle invasion. Two T2 hypointense regions with diffusion restriction (grade 4-5 diffusion intensity) are seen at the right basal segment anterior and posterior peripheral zone measuring smaller than 1cm in diameter regions (PI-RADS 4). Otherwise, ill-defined linear T2 hypointensities in peripheral zone without substantive evidence of diffusion restriction suggestive of fibrotic changes. Ectopic nodule is seen in the left mid segment peripheral zone. Two focal areas of moderate to severe diffusion restriction in the basal segment transitional zone in the areas of T2 hypointensity with obscured margins (PI-RADS 3). 

Bilateral neurovascular bundles are clear. 

T2 intermediate signal intensity with T1 slightly hyperintense appearance in the seminal vesicles suggestive of hemorrhagic content. 

Urinary bladder is partially flow and demonstrates a 1cm in diameter true diverticula in the anterior aspect. A few tiny lymph nodes are seen in the obturator regions. Multiple, smaller than 1cm in diameter in short axis lymph nodes with fatty hilum are seen in bilateral inguinal regions, benign in imaging characteristics. 

Rectal wall is intact. 

Metallic susceptibility artifact in the lower lumbar spine suggestive of surgery. Metallic susceptibility artifacts in the scrotum, likely representing clips. 


CONCLUSION

Dominant lesion is a 1cm by 1.2cm T2 hypointensity with grade 5 diffusion restriction at the left basal segment posterior peripheral zone, which also represents early arterial enhancement (PI-RADS 4). Two T2 hypointense regions with diffusion restriction (grade 4-5 diffusion intensity) at the right basal segment anterior and posterior peripheral zone measuring smaller than 1cm in diameter regions (PI-RADS 4).


Discussion
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