MRI - mpMRI
Axial T1
Sagittal T2
Coronal T2
Axial T2
Axial DWI
Axial ADC
Axial DCE
Axial CAD
What is the percentage of prostate cancers that originate in the peripheral zone?
Approximately 70-75% of prostate cancers originate in the peripheral zone.
Are there imaging signs of extraprostatic extension?
Yes, there is a broad capsular contact (≥15 mm) of the right posterolateral border. So there is a fair chance of extraprostatic extension.
Findings:
Quality: mild geometric distortion on DWI, does not compromise diagnostic confidence
Prostate size: 50 x 34 x 60 mm (CC x AP x ML) ≈53 mL, PSA density ~0.17 ng/mL2
Haemorrhage: none
Peripheral zone (PZ): uniform hyperintense signal with two focal findings as below
Focal lesion #1:
- location: right apical/midglandular posterolateral peripheral zone (PZpl), visible on axial images (ima 10-12), sagittal images (ima 20)
- lesion size: 18 x 10 x 17 mm
- T2w: circumscribed, homogenous moderate hypointense focus - category 5/5
- DWI: markedly hyperintense on DWI (b1000) and markedly hypointense on ADC focus - category 5/5
- DCE: focal early enhancement - positive
Focal lesion #2:
- location: right basal posterolateral peripheral zone (PZpl), on axial images (ima 15), sagittal images (ima 20)
- lesion size: 8 x 7 x 8 mm
- T2w: circumscribed, homogenous moderate hypointense focus - category 4/5
- DWI: markedly hyperintense on DWI (b1000) and markedly hypointense on ADC focus - category 4/5
- DCE: focal early enhancement - positive
Transition zone (TZ): moderate heterogeneity, multiple BPH nodules and a focal finding as below:
Focal lesion #3:
- location: left mid gland anterior transition zone (TZa), on axial images (ima 11-13)
- T2w: heterogeneous low signal intensity with obscured margins - category 3/5
- DWI: isointense on DWI (b1000) and markedly hypointense on ADC - category 3/5
- DCE: focal early enhancement - positive
Prostate margin: lesion #1 with broad capsular contact (~17 mm) along with some irregularity, lesion #2 also with capsular contact
Overall PI-RADS category: 5
Neurovascular bundles: adjacent to lesion #1 and lesion #2
Seminal vesicles: not involved
Lymph nodes: multiple small oval iliac lymph nodes (up to 8 mm size, fatty hilum, smooth margins)
Pelvic bones: a severe case of right hip osteoarthritis, no signs of bony metastasis
Impression:
Very highly and highly suspicious lesions of the right apical/mid gland and basal, posterolateral peripheral zones (PZpl) with capsular contact - PI-RADS 5.
A further questionable finding of the left transition zone - PI-RADS 3.
MRI putative stage: cT3aNxMx.
A prostate biopsy was recommended.