5b (Prostate) - Answer: 60-year-old male presents with increasing PSA levels

HISTORY: 

This 60-year-old male presents with increasing PSA levels which measured 4.56ng/mL in month one, then 4.48ng/mL in month six, and 5.76ng/mL in month 12. Prior TRUS biopsy revealed PIN.


PRIMARY FINDING: 

PI-RADS IV.


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


FINDINGS:

The prostate gland measures 4.4cm in CC, 5.3cm in RL and 4.2cm in AP dimensions. Calculated prostate volume is 64cc and PSA density is 0.09. Transitional zone of the prostate gland demonstrates mild hyperplasia. A 1.5cm x 0.8cm T2 hypointensity with restricted diffusion and hypovascularity is noted in the left mid segment transitional zone concerning for malignant neoplastic process, PI-RADS 4. Bulging of the surgical capsule is noted. No T2 hypointensity concerning for neoplastic process in the peripheral zone. Anatomical prostate capsule, bilateral neurovascular bundles and bilateral seminal vesicles are unremarkable. 

No enlarged lymph nodes identified in the pelvis or inguinal regions. No free fluid. 

Partially full urinary bladder demonstrates mild wall thickening. 


CONCLUSION

PI-RADS 4, a 1.5cm x 0.8cm T2 hypointensity with restricted diffusion and hypovascularity is noted in the left mid segment transitional zone "Lmtz" concerning for malignant neoplastic process.


Discussion
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