Prostate cancer - extraprostatic extension

Findings:

Quality:  mild geometric distortion on DWI, does not compromise diagnostic confidence

Prostate size:    40 x 32 x 41 mm (CC x AP x ML) ≈ 27 mL, PSA density ≈ 0.42 ng/mL².

Haemorrhage: none none

Peripheral zone (PZ):  heterogeneously slightly, decreased signal, linear/wedge-shaped hypointensities

Transition zone (TZ):  moderate heterogeneity, focal finding as below:

Focal lesion #1:

Location:  left mid gland anterior transition zone from (LM-TZa) extending to the right and from apical to basal.

Lesion size:  21 x 13 x16 mm

T2w: circumscribed homogeneous, hypointense: “erased charcoal sign”, with capsular contact and bulge anteriorly - category 5/5

DWI: focal slightly hyperintense on DWI (b1000) and markedly hypointense on ADC - category 3/5

DCE: focal early enhancement - positive

Prostate margin:  capsular contact, bulge and breach of the left anterior margin

Lesion overall PI-RADS category:  5

Seminal vesicles:  not involved

Lymph nodes:  enlarged lymph node adjacent to the left internal iliac vessels (≈11mm), the round suspicious lesion (≈6mm) in the preprostatic fat tissue

Pelvic bones: no osseous metastases

Other pelvic organs: right bladder diverticulum

Impression:

Very highly suspicious lesion in the left anterior transition zone (TZa) and anterior fibromuscular stroma (AFS) with extraprostatic extension.

Highly suspicious lymph nodes in the left iliac fossa and in the preprostatic fat tissue.

MRI putative stage cT3a - PI-RADS 5

Prostate biopsy was recommended.