65-year-old man with history of Gleason 9 prostate adenocarcinoma in the left lateral base, right lateral base, and right mid gland on outside biopsy from 9/1/2016. PELVIS:PROSTATE:Prostate Size: 38 x 31 mm.Peripheral Zone: Multiple areas of markedly decreased T2 signal and ADC abnormality identified in the peripheral zone. The first in the right mid gland (301/48) measures 18 x 16 mm and appears to extend beyond the prostatic capsule (301/49) and involve the neurovascular bundle. This area of signal abnormality may be confluent with an area of abnormality in the right base (301/56) which measures 16 x 14 mm and also extends beyond the prostatic capsule. These areas of signal abnormality are also seen to be enhancing and there is abnormal enhancement of the right lateral urethra in the mid gland (1401/1531).An additional area of signal abnormality in the left base (301/60) measures 10 x 7 mm.Central Gland: The central gland is unremarkable.Seminal Vesicles: The right-sided tumor appears to be the right seminal vesicles and abuts the left seminal vesicle.Extracapsular Extension: Extracapsular extension of the right prostatic tumor with involvement of the neurovascular bundle. Left base tumor also appears to extend beyond the prostatic capsule.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple enlarged lymph nodes are seen bilaterally. Enhancing right iliac lymph node (1601/135) measures 11 mm. Enlarged left obturator lymph node is partially visualized (301/99) and measures 9 mm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Multiple sites of prostatic signal abnormality in the right mid gland, right base, and left base highly suspicious for adenocarcinoma.2.Extracapsular tumor extension with involvement of the urethra, seminal vesicles bilaterally, and the neurovascular bundle on the right.3.Bilateral pelvic lymphadenopathy suspicious for nodal metastases.