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 (≥25mm). So there is a fair chance of extracapsular extension.
Are there imaging signs of seminal vesicle invasion?
On thorough inspection, one can presume tumour extending from the right base to and around the right seminal vesicle.
Quality: mild to moderate geometric distortion on DWI, does not compromise diagnostic confidence
Prostate size: 38 x 32 x 50 mm (CC x AP x M) ≈32 mL, PSA density ~0.24 ng/mL2
Haemorrhage: none
Peripheral zone (PZ): uniform hyperintense signal with one focal finding as below:
Focal lesion #1:
- location: right basal posterolateral peripheral zone (PZpl), visible on axial images (ima 10-12), sagittal images (ima 14-19)
- lesion size: 13 x 15 x 25 mm
- T2w: non-circumscribed, homogenous mild to moderate hypointense focus - category 3/5
- DWI: markedly hyperintense on DWI (b1000) and markedly hypointense on ADC focus - category 5/5
- DCE: focal early enhancement - positive
Transition zone (TZ): moderate heterogeneity, multiple BPH nodules
Prostate margin: lesion #1 with broad capsular contact (~25 mm)
Overall PI-RADS category: 5
Neurovascular bundles: directly adjacent to lesion #1
Seminal vesicles: asymmetric hypointense signal intensity around the right ejaculatory duct and extending from the base of the prostate into and around the right seminal vesicle (ima 17)
Lymph nodes: no enlarged or suspicious lymph nodes
Pelvic bones: no signs of bony metastasis
Impression:
Highly suspicious lesion of the right basal, posterolateral peripheral zone (PZpl) with probable extraprostatic extension and possible seminal invasion - PI-RADS 5.
A prostate biopsy was recommended.