Patient was initially noted to have a rise in his PSA to 4.8 ng/mL in 2013 during routine screening. Per pt, a TRUS biopsy was performed a that time with a small focus of Gleason 6 disease. He elected to undergo active surveillance. His last TRUS biopsy was in 2015 and per pt was negative for disease. Recently his PSA has risen to 6.8 on 11/7/2016, from 5.7 on 4/5/16. PELVIS:PROSTATE:Prostate Size: 4.9 x 3.8 x 4.6 cmPeripheral Zone: 14 x 6 mm left ADC low (series 308 image 384) and T2 low (series 501 image 19) near the junction of the peripheral zone and central zone. There is enhancement of this lesion (series 1201 image 2970).Central Gland: Multiple hyperplastic nodules, one of them may have focal hemorrhage.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No definite evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Bilateral nonenlarged nonspecific external iliac lymph nodes. Questionable nonspecific retroperitoneal lymph node only seen on sequence 1401 near the aortic bifurcation.BONES, SOFT TISSUES: Soft tissue density in the left inguinal canal is presumably from inguinal hernia repair, please correlate with prior surgical history.OTHER: No significant abnormality noted.
1.Left peripheral lesion as above, intermediate, PI-RADS 3.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