Locally advanced prostate cancer
Low back pain. Sclerotic bone lesions on radiograph. Ultrasound demonstrates bilateral hydronephrosis together with an enlarged prostate. PSA is elevated. MRI for further investigation
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Enlarged prostate infiltrated with tumour extending anteriorly into the bladder base (arrow), laterally into the distal ureters (especailly on the left) - arrow, posteriorly into the right seminal vesicle and the anterior wall of the rectum (arrow). Note multiple lesions in the pelvic bones showing restricted diffusion (b value of 800 msec) indicative of metastasis.
Local staging of prostate cancer is usually performed as a multiparametric technique ie T2 signal, DWI and perfusion (+/- spectroscopy). In this case the anatomical changes are dramatic.