58 year old male patient with biopsy proven prostate cancer. Evaluate extent of prostate cancer invasion. PELVIS:PROSTATE:Prostate Size: 4.6 x 2.8 x 3.5 cm. Peripheral Zone: There is a region of T2 hypointensity and corresponding low ADC values extending from the right base to mid gland of the peripheral zone compatible with tumor. This measures approximately 1.0 x 0.5 cm in one region (image 19, series 901). The capsule overlying this lesion is indistinct compatible with extraprostatic extension and there is questioned involvement of the adjacent neurovascular bundle on the right.There is an additional smaller focus of signal abnormality within the left mid-gland measuring 0.5 x 0.4 cm which is also suspicious for tumor (image 20, series 901). Central Gland: There are BPH nodules.Seminal Vesicles: No definite involvement.Extracapsular Extension: As described above.BLADDER: There is irregularity and thickening of the inferior bladder wall. These regions of abnormality are intrinsically high on T1 which limit evaluation for enhancement.LYMPH NODES: Non-specific external iliac lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There are asymmetric dilated venous vessels anterior to the right gluteus musculature.
1.Large area of signal abnormality within the right mid-gland and right base of the peripheral zone most compatible with neoplasm and with extraprostatic extension and questioned involvement of the neurovascular bundle.2.Smaller lesion within the left mid-gland of the peripheral zone also suspicious for prostatic neoplasm.3.Significant irregularity and thickening of the bladder wall is concerning for neoplasm; direct visualization is recommended for further evaluation. 4. Asymmetric prominent posterior right lower extremity veins. While this could be normal anatomy, collateral vessel formation is another consideration in the setting of chronic deep venous thrombosis; if there is clinical concern for DVT, ultrasound may be considered. 