Findings:
Quality: increased noise, some geometric distortion on DWI, does not compromise diagnostic confidence
Prostate size: 44 x 36 x 49 mm (CC x AP x ML) ≈40 mL, PSA density ~0.19 ng/mL2
Haemorrhage: none
Peripheral zone (PZ): bilateral heterogeneous signal alteration in T2w imaging, focal finding in a left posterior basal location
focal lesion #1 (PZpl):
- location: left basal posterolateral peripheral zone (PZpl)
- lesion size: ~14 mm
- T2W: homogeneous, hypointense focus
- DWI: markedly hyperintense on DWI (b1400) and markedly hypointense
- DCE: focal early enhancement - positive
Transition zone (TZ): moderate heterogeneity, some BPH nodules
Prostate margin: capsular contact, no bulge or breach
Overall PI-RADS category: 4/5
Neurovascular bundles: probably not involved
Seminal vesicles: contracted, not involved, but close proximity of the lesion to the proximal part of the left seminal vesicle
Lymph nodes: multiple small oval iliac lymph nodes (up to 6 mm size, fatty hilum, smooth margins)
Pelvic bones: no osseous metastases, a right-sided hip endoprosthesis
Other pelvic organs: normal
Impression:
A highly suspicious lesion in the left basal peripheral zone(PZpl) - PI-RADS 4.
A prostate biopsy was recommended.