57-year-old male with elevated PSA and negative TRA. Negative biopsy x1. Evaluate for suspicious lesions. PELVIS:PROSTATE:Prostate Size: The prostate measures 5 cm in transverse, 3 cm in AP, and 4.4 cm in craniocaudal diameter.Peripheral Zone: There is nonspecific diffuse T2 hypointense signal intensity of the peripheral zone. In the left base/mid gland, there is a 5 x 8 mm focus of hypointensity ADC signal (axial series 809 image 304). At the same level on the right, there is a 4 mm additional focus of hypointense ADC signal. No abnormal early contrast enhancement. There are additional ill-defined areas of ADC hypointense signal at the apex (axial series 809 image 264).Central Gland: Heterogenous appearance of BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific external iliac lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
The background ill-defined diffuse T2 hypointense signal of the peripheral zone could represent diffuse prostatitis and limits evaluation for underlying lesions. Underlying malignancy cannot be excluded - two more focal areas as described above could be targeted for biopsy if indicated.