Newly diagnosed organ-confined intermediate risk prostate cancer. He was recently noted to have a rise in his PSA to 5.49 ng/mL with 13% free on 9/7/2016. He had previously had a rising PSA (4.6 in 2/2016, 5.0 3/2016). This prompted a transrectal ultrasound and prostate biopsy which revealed a Gleason 3+4 =7 in 1 of 12 cores and Gl 3+3=6 in 5/12 cores. The positive finding was on the right lobe (R apex) with maximum involvement of 80%. PELVIS:PROSTATE:Prostate Size: 4.5 x 2.6 x 3.5 cmPeripheral Zone: There is a 7 x 5 mm T2 low (series 301 image 88) ADC low (series 408 image 304) focus in the right peripheral zone with early enhancement.Central Gland: Multiple hypoplastic nodules noted.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Signal abnormality in the right peripheral zone as above, PIRADS 4.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