Presentation
Intermediate-risk prostate cancer. Prostate-specific antigen (PSA) 4.5 ng/mL. Radiation therapy planning.
Patient Data
Findings:
Quality: some movement on sagittal images, does not impair diagnostic confidence
Prostate size: 60 x 47 x 52 mm (CC x AP x ML) ≈ 76 mL, PSA density ≈ 0.06 ng/mL2
Hemorrhage: mild bleeding in the right posterolateral apical peripheral (RA-PZpl) and left posterior transition zone (LM-TZp).
Peripheral zone (PZ): in T2w hypointense focus (≈ 9mm), markedly hyperintense in b1400 and markedly hypointense in ADC with capsular contact (10-15mm) and a small capsular bulge, otherwise diffuse hypointense
Transition zone (TZ): heterogeneity, multiple mostly encapsulated BPH nodules, normal surgical capsule
Neurovascular bundles: symmetric
Seminal vesicles: no signs of invasion
Lymph nodes: oval external iliac lymph nodes (up to 6 mm size, smooth margins)
Pelvic bones: small lesion in the right femoral head very likely bone island, no definite signs of bony metastasis
Sigmoid diverticulosis.
Impression:
A single small lesion in the right apical posterolateral peripheral zone (RA-PZpl), consistent with the histologically proven prostate cancer.
An extraprostatic extension is possible.
MRI putative stage: cT3aNxMx
Key findings:
Hypointense focus in T2w imaging with a small capsular bulge (red arrowheads), markedly hyperintense in b1400 and markedly hypointense in ADC (blue arrowheads).
Biopsy results:
Histology of the US-guided systematic biopsy 2 months prior to the MRI showed an acinar adenocarcinoma (modified Gleason score 4+4=8, high grade within one core and 4+3=7b within two cores) of the right apical and mid gland. The 9 remaining biopsy cores were negative.
Case Discussion
This case illustrates a histologically proven small prostate cancer.
Histology of the systematic biopsy was showed an acinar adenocarcinoma (modified Gleason Score 4+4=8, grade 3).
MRI was done for radiation therapy planning and staging purposes and shows a single small lesion in the right apical posterolateral peripheral zone and this finding correlates well with the results from the systematic biopsy.
There is a small capsular bulge visible in the axial images consistent with possible extraprostatic extension.
The patient receives intensity-modulated radiotherapy.