Presentation
PSA 7.8. Right lobe nodule on PR examination.
Patient Data
Prostate volume 130mls. PSA density 0.06ng/ml.
Virtually all of the prostate gland is composed of BPH with a thin residual peripheral zone. Median lobe hypertrophy protruding into the urinary bladder.
No significant PIRADS abnormality.
Normal seminal vesicles. No pelvic lymphadenopathy. No sinister bone lesion.
Diffuse bladder wall hypertrophy. 7 mm left-sided bladder diverticulum.
Case Discussion
The typical appearances of benign prostate hypertrophy on MRI with media lobe hypertrophy protruding into the urinary bladder and the compression and thinning of the peripheral zone.
What as first appears like a concerning PSA value in patients with large glands becomes a very low PSA density for the purposes of calculating the likely risk of malignancy.
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