57-year-old male. Evaluate for prostate cancer. PSA was 3.6 ng/mL on 6/16/2016.Prostate biopsy from 7/18/2016:Right mid medial: Adenocarcinoma, Gleason 3+3Left base lateral: Atypical small acinar proliferation adjacent to high-grade prostatic intraepithelial neoplasm.Left mid medial: Adenocarcinoma, Gleason 3+3Left apex medial: Adenocarcinoma, Gleason 3+3Left apex lateral: Adenocarcinoma, Gleason 3+3 PELVIS:PROSTATE:Prostate Size: The prostate measures 5.8 cm in transverse, 3.3 cm in AP, and 5.2 cm in craniocaudal diameter.Peripheral Zone: In the left mid gland, there is a 4 x 4 mm ADC and T2 hypointense focus suspicious for malignancy (series 201 image 51, series 303 image 304).Central Gland: In the left transitional zone, there is a well-defined T2 and ADC hypointense focus measuring 4 x 6 mm (series 303 image 224, series 701 image 12, series 201 image 41). The ADC appearance is particularly low in signal intensity.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No suspicious pelvic lymphadenopathy.BONES, SOFT TISSUES: A well-defined T2 and T1 hypointense focus adjacent to the right pelvic sidewall demonstrates dense calcification on the 12/20/2016 abdominal radiograph and is compatible with a benign phlebolith (series 201 image 68).OTHER: No significant abnormality noted.
1.In the left mid gland, there is a 4 x 4 mm ADC and T2 hypointense focus concerning for malignancy (PI-RADS 4).2.Suspicious well-defined T2 hypointense and very low ADC hypointense focus in the left transitional zone measuring 4 x 6 mm (PI-RADS 3).PI-RADS™ v2 Assessment Categories:PI-RADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PI-RADS 2 – Low (clinically significant cancer is unlikely to be present)PI-RADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PI-RADS 4 – High (clinically significant cancer is likely to be present) PI-RADS 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