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Large heterogenous partially necrotic mass within the pelvis measuring 75 x 62 x 113mm, favoured arising from the prostate, involving the pelvic floor, inseparable from the prostate and seminal vesicles with posterior displacement of the rectum. There is a loss of the fat plane between the lesion and the anterior aspects of the left internal obturator and levator muscles as well as the rectum extending from 10 o'clock to 3 o'clock position. This lesion appears continuous with the base of the bladder.
Bulky tumour deposits along the mesorectal vessels with bilateral external, internal and mesorectal lymphadenopathy. No inguinal lymphadenopathy. Malignant appearing left para-aortic lymph node.
Conclusion:
- appearance highly suspicious for aggressive prostate malignancy with an invasion of the bladder base the lower rectum and possibly the pelvic sidewall
- tumour deposits with vascular invasion throughout the mesorectum with bilateral malignant iliac and left para-aortic lymphadenopathy
- lesion amenable to trans-rectal biopsy