Reason: staging exam, biopsy scheduled History: Prostate cancer treated with cyberknife in 2010, rising PSAFrom Epic: Gleason 4+3=7 treated with Cyberknife radiotherapy without ADT in May 2010. His PSA did nadir at approximately 2 ng/mL and has had consecutive rising PSA values since October 2015. The most recent PSA is 7.95 ng/mL on 4/14/2016. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.9 x 4.6 cmPeripheral Zone: T1 signal in the right mid peripheral zone associated with heterogeneous T2 signal likely represents hemorrhage. There is ill-defined hypointense T2/ADC signal in the mid to base peripheral zone, medial to the region of hemorrhage. No measurable lesion is identified.Central Gland: BPH nodules.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: Enhancement at the hamstring origins may reflect tendinosis. Enhancement within the sacrum adjacent to the right sacroiliac joint is likely degenerative.OTHER: No significant abnormality noted.
1.Limited exam due to therapy-related changes. There is ill-defined low T2/ADC signal in the central peripheral zone of the mid gland and base but no definite measurable lesion. However, given the pronounced therapy-related changes, cancer in this region cannot be excluded.