Prostatic carcinoma

Case contributed by Dr Varun Babu

Presentation

Weak stream and nocturia in a long standing diabetic. Lab investigation revealed an elevated PSA.

Patient Data

Age: 70 years
Gender: Male
MRI

Prostate is normal in size weighing 16 g, with mild median lobe hypertrophy invading into the urinary bladder. Loss of normal T2 high signal intensity of the left half of the peripheral zone, which is replaced by a T2 hypointense lesion which is crossing the midline, breaching prostatic capsule and invading left neurovascular bundle. Seminal vesicles and vas deferens are normal. 

Case Discussion

Patient underwent cystoscopy and biopsy which revealed prostatic adenocarcinoma with perineural invasion. Gleason score 7 (3+4). 

While T2 weighted images are the primary determining sequence for assessing the transition zone using the PI-RADS scoring system, it is useful for detection of peripheral zone lesions as well, whilst the DWI sequence is the primary determining sequence for peripheral zone lesions. Any ambiguity in either of these sequences may be elucidated by the supplemental dynamic contrast-enhanced MRI sequence.

Following the latest version of PI-RADS will enable a standardization in reporting prostate MRI studies.

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Case information

rID: 57192
Published: 12th Dec 2017
Last edited: 14th Aug 2019
System: Urogenital
Inclusion in quiz mode: Included
Institution: Vivid Diagnostic Centre

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