62-year-old male with elevated PSA, enlarged prostate. Questioning abnormal PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.4 cm in transverse, 4 cm in AP, and 4.8 cm in craniocaudal length.Peripheral Zone: In the mid gland left peripheral zone, there is a 17 x 12 mm ADC and T2 hypointense focus suspicious for a dominant lesion (series 301 image 42, series 403 image 224), and indistinctness of the hypointense capsule is concerning for extracapsular extension (series 301 image 42). Central Gland: Nodular changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: As above.BLADDER: Asymmetric thickening at the level of the left UVJ (series 601 image 64)LYMPH NODES: Nonspecific left external iliac lymph node measuring 1.3 x 0.4 cm (series 601 image 60).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Dominant lesion in the left peripheral zone mid gland measuring 17 x 12 mm with suspected extracapsular extension (PI-RADS 5).2. Asymmetric thickening at the level of the left UVJ within the bladder, possibly mass, would be better characterized with direct visualization. No prior studies are available for comparison.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf