MRI - Biparametric MRI of the prostate (bpMRI)
Axial T1
Sagittal T2
Coronal T2
Axial T2
Axial DWI (b1000)
Axial DWI (b1400)
Axial ADC
Are there imaging signs of extraprostatic extension?
Yes, there is a broad capsular contact and there are signs of a capsular breach in the left posterolateral base.
Are there signs of seminal vesicle invasion?
Yes, there is a moderate hypointense signal in T2w images and diffusion restriction of the left seminal vesicle as well as an asymmetry of the central zone suggestive of seminal vesicle invasion.
Which types of seminal vesicle invasion do exist?
According to the ACR PI-RADS v2.1 document, there are 3 types. Tumour extension along the ejaculatory duct into the seminal vesicle above the prostate, direct extra-glandular tumour extension from the base of the prostate into and around the seminal vesicle and metachronous tumour deposits.
Findings:
Quality: some patient movement between sequences, does not impair diagnostic confidence
Prostate size: 43 x 35 x 47 mm (CC x AP x ML) ≈37 mL, PSA density ~0.33 ng/mL2
Haemorrhage: small bleeding in the left posterior transition zone
Peripheral zone (PZ): focal findings as below, beyond that mild hypointensities
Focal lesion #1:
- circumscribed T2 homogenous moderate hypointense focus (18 x 10 x 15 mm) of the left midglandular, anterior and apical, peripheral zone (PZa) with diffusion restriction and indistinct margin of the pseudocapsule
- visible on axial images and sagittal images
Focal lesion #2:
- circumscribed T2 homogenous moderate hypointense focus (25 x 10 x 15 mm) of the left posterolateral base with a capsular breach, and diffusion restriction
- adjacent asymmetric moderate hypointense signal intensity in the left central zone (CZ) surrounding the left ejaculatory duct and extending into the left seminal vesicle
- visible on axial, sagittal and coronal images
Focal lesion #3:
- thin, circumscribed T2 homogenous moderate hypointense focus (8 x 2 x 8 mm) of the midglandular peripheral zone (PZpl) adjacent to the capsule
- visible on axial images and coronal images
Transition zone (TZ): moderate heterogeneity, multiple BPH nodules, indistinct pseudocapsule left mid gland anterior and left posterior transition zone
Prostate margin: lesion #2 with capsular contact and breach
Neurovascular bundles: probably involved
Seminal vesicles: left seminal vesicle hypointense with diffusion restriction suggestive of seminal vesicle invasion
Lymph nodes: round lymph node (6 mm size, fatty hilum) in the left perirectal fat tissue, oval external iliac lymph nodes (up to 5 mm size, fatty hilum, smooth margins)
Pelvic bones: no signs of bony metastasis
Impression:
Multifocal prostate cancer with lesions in the left anterior peripheral zone and with involvement of the pseudocapsule and in the posterior mid gland and base with probable infiltration of the left central zone.
There is a possible small lesion of the right midglandular, posterolateral peripheral zone.
There are signs of extraprostatic extension at the posterolateral base and signs of left seminal vesicle invasion.
MRI putative stage: cT3bNxMx