62-year-old male with prostate cancer. PSA 22.76 ng/mL on 3/29/2016Biopsy from 12/16/2016 showed:Right apex: Benign prostatic tissueRight mid gland: adenocarcinoma, Gleason 4+5Right base: Adenocarcinoma, Gleason 4+5Left apex: Adenocarcinoma, Gleason 4+5Left mid colon adenocarcinoma, Gleason 4+5Left base: Adenocarcinoma, Gleason 4+5 PELVIS:PROSTATE:Prostate Size: The prostate measures 6.3 cm in transverse, 4.4 cm in AP, and 4.9 cm in craniocaudal length.Peripheral Zone: In the right mid gland, there is a 7 x 3 mm ADC and T2 hypointense suspicious focus (series 408 image 264, series 701 image 15). Additional small 5 x 4 mm T2 and ADC hypointense focus in the right base also suspicious for malignancy (series 701 image 20, series 408 image 344).No dominant lesions on the left are identified to correlate with the biopsy history.Central Gland: In the posterior transitional zone, there is a 10 x 13 mm ADC hypointense focus (series 408 image 344) that could represent an additional site of disease.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No definite extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Right internal iliac lymph node measuring 1.5 x 1.4 cm (series 1501 image 107).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Suspicious T2 and ADC hypointense foci in the right mid gland (PI-RADS 5), and right base (PI-RADS 4), and posterior transitional zone (PI-RADS 4).2.Mildly enlarged right internal iliac lymph node suspicious for metastatic disease.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