0:00

50-year-old with a PSA of four, a benign gland

0:04

on exam and no obstructive urinary symptoms.

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So we've brought up our axial T2, our ADC map windowed

0:12

at 1400x1400, a synthetically created B equal 1600 image,

0:18

and the arterial phase of the dynamic post-contrast series.

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And what you'll notice, starting looking in the

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peripheral zone, is that most of the

0:27

peripheral zone is uniformly high T2 signal.

0:30

There are some linear areas of low signal, which is normal.

0:33

And then here in the anterior

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peripheral zone, there's about a 1.

0:36

8 centimeter, uh, very well-defined T2 dark nodule.

0:42

It's an absolute black hole on the ADC map.

0:45

The ADC values are very low; they

0:47

measure in the 600s, here 676.

0:51

This region is high signal on the high B

0:54

value image, and it does focally enhance.

0:57

Uh, in the arterial phase, uh, following contrast.

1:00

Uh, so this is a PI-RADS 5 lesion, and it's located

1:04

in the anterior gland, so this wouldn't be palpable.

1:06

The posterior gland is palpated, and this

1:09

also likely would have been missed if the

1:10

person had had a systematic trans-rectal ultrasound biopsy.

1:13

Um, the remainder of the peripheral zone looks okay.

1:16

There's no other areas of diffusion restriction.

1:18

The transition zone is mildly enlarged.

1:21

This is kind of a normal appearance

1:22

of prostatic hypertrophy.

1:24

You'll notice here and here are as normal, uh, central zone.

1:29

This is what it looks like.

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diffusion restriction in the central zone.

1:34

That's normal.

1:35

Uh, there's no extracapsular extension.

1:39

Seminal vesicles look fine.

1:41

Let's find those for you.

1:44

There's no abnormal soft tissue or enhancement

1:47

along the course of the neurovascular bundles,

1:48

kind of expected given the anterior tumor.

1:50

So this is a PI-RADS 5.

1:52

Uh, and when it was biopsied, uh, we got predominantly, uh,

1:57

4 plus 3 and 4 plus 4, so very high-grade disease, which

2:00

is concordant with the very low ADC values in the 600s.