Presentation
Elevated PSA level.
Patient Data
There is a small (15 x 11 mm) T2 hyposignal nodule at the left peripheral zone which shows DWI restriction and early enhancement and wash out in the post Gd images.
Transition zone is enlarged due to BPH changes and without suspicious nodule.
No extracapsular extension. No seminal vesicle invasion.
No significant lymph nodes. No suspicious bone lesions.
Case Discussion
PI-RADS (Prostate Imaging Reporting and Data System) determination is dependent on whether the lesion is in the peripheral zone (PZ) or transition zone (TZ).
For PZ the primary determining sequence is DWI. That is, the PI-RADS score is determined by DWI appearance, with the exception of PI-RADS 3 lesions, at which further reference is made to the presence or absence of dynamic contrast enhancement (DCE) in an attempt to minimise "indeterminate" lesions.
In this case, regarding the imaging findings and the PI-RADS (Prostate Imaging Reporting and Data System), prostate adenocarcinoma is suggested with the overall grading of PI-RADS 4.
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