Presentation
History bladder tumor. Post surgery, BCG and interferon. PSA 5. Rule out prostate carcinoma.
Patient Data
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Focal highly suspicious lesion in the left posterior and posterolateral PZ base. Homogenous hypointense on T2WI. Broad-based capsular bulging raises the possibility of extracapsular invasion. Restricted diffusion with an ADC value of 550. Type 3 enhancement curve. Overall PIRADS score 5/5.
Case Discussion
TRUS biopsy showed granulomatous prostatitis and no carcinoma.
Granulomatous prostatitis is a well described known mimicker of prostate carcinoma, clinically and on MRI. Clinically it often presents with elevated PSA and a firm nodule on DRE. On MRI, the lesion demonstrates typical features of a highly suspicious neoplastic lesion.
Currently, histopathology is the only means of establishing the diagnosis and excluding a tumor.
Possible causes include previous intravesical BCG treatment for bladder carcinoma, TB prostatitis, previous intervention (eg TURP) and idiopathic.