Prostate cancer - locally progressive (T3b)

Findings:

Quality:  apex of the prostate cut off in axial T2-weighted and DWI images, does not compromise diagnostic confidence

Prostate size:  71 x 46 x 56 mm (CC x AP x ML) ≈95 mL, PSA density ~0.06 ng/mL²

Hemorrhage:  diffuse subacute hemorrhage in the apical and midglandular peripheral and transitional zone right>left with inhomogeneously intermediate to low signal on T2-weighted images with interspersed areas of high signal and high signal in T1-weighted images

Peripheral zone (PZ):  diffusely hypointense bilaterally with broad capsular contact and some residual heterogeneous signal in the right basal and midglandular anterior zones

Transition zone (TZ):

• central  periurethral defect after transurethral resection of the prostate (TURP)

• some BPH nodules in the midglandular anterior transition zone (TZa)

• diffuse homogeneous moderate hypointense signal in the midglandular and basal posterior transition zone (TZp) with obscured/indistinct pseudocapsule

Prostate margin: highly irregular with a capsular breach and tumor extension

Neurovascular bundles: asymmetry and invasion of the left neurovascular bundle

Seminal vesicles: extension of T2w hypointensity and diffusion restriction along the ejaculatory ducts above the base and within the inferior portion of the left seminal vesicle, bleeding in the mid and lateral portions of left seminal vesicle

Lymph nodes: suspicious, enlarged left external iliac lymph node

Pelvic bones: no signs of bony metastasis

Impression:

Histologically proven prostate cancer post transurethral resection of the prostate (TURP), with infiltration of both lobes from basal to apical with extraprostatic extension (EPE) and left seminal vesicle invasion (SVI).

Extensive prostatic hemorrhage predominantly in the apical and posterior midglandular zones.

MRI putative stage: cT3bN1Mx

Key findings:

• large prostatic hemorrhage in the apical and midglandular zone of the prostate (blue arrows) - best visible in T1-weighted images, due to the paramagnetic effect of methemoglobin 
• extensive tumor growth in the base and midglandular zones of the prostate expressed by the "erased charcoal sign" (red arrows) with correspondent hyperintensity in b1400 images (red arrowheads) with irregular prostatic margins, breaches, and neurovascular bundle asymmetry (green arrowhead)
• tumor invasion of the inferior portion of the left seminal vesicle (orange arrowhead)
• bleeding/hemorrhage in the mid and lateral portion of the left seminal vesicle (blue arrowheads)