Presentation
Elevated prostate-specific antigen (PSA) , 12 ng/mL
Patient Data
There is a circumscribed, moderately hypointense mass involving the right mid-to-basal peripheral zone with extracapsular spread, measuring approximately 2.5 x 1.5 cm. Additionally, there is a hypointense nodule involving the prostate apex, measuring 1.1 cm. Both lesions show restricted diffusion on ADC sequence. Both lesions show delayed enhancement on the DCE sequence.
Shotty lymph nodes are present.
Case Discussion
The three MRI components of the PI-RADS are the DWI/ADC, T2W and DCE sequences. When T2W and DWI/ADC are of diagnostic quality, DCE is of a minor value in the designation of PI-RADS assessment, primarily for upgrading PI-RADS 3 to 4 if pathologic enhancement is present.
Since the dominant sequences for assessing PI-RADS are T2W sequence for the transition zone and the DWI sequence for the peripheral zone, the determination of the location whether in the peripheral zone or transition zone is essential.
In this case there is a 2.5 x 1.5 cm DWI bright lesion involving the right mid-to-basal peripheral zone, that shows restricted diffusion, this lesion is consistent with PI-RADS 5 based primarily on the DWI/ADC, since the lesion is in the peripheral zone. There is possible extraprostate spread.
A smaller 1.2 cm non-well-circumscribed T2W hypointense nodule within the prostate apex, shows restricted diffusion and delayed enhancement on the DCE, consistent with PI-RADS 4.