TCIA IDProstateDx-01-0001ProstateDx-01-0002ProstateDx-01-0003ProstateDx-01-0004ProstateDx-01-0005ProstateDx-01-0006ProstateDx-01-0007ProstateDx-01-0008ProstateDx-01-0009ProstateDx-01-0010ProstateDx-01-0011ProstateDx-01-0012
Backgroundhistory of prostate cancer and radiation therapy more than 10 years ago; now rising PSANewly diagnosed prostate cancer Clinical diagnosis: Increased PSA.cancer in the bilateral prostate on core needle biopsy. Gleason score 6 on right, 7 on left; PSA 6.3prostate cancer, biopsy proven, 4+3=7 Gleason score on the left sidebilateral prostate cancer. Gleason score 8; PSA 15diagnosed prostate cancer Gleason's score 7 on recent biopsy; patient on active surveillanceprostate cancer Gleason 3 + 4 and PSA of 13.5prostate cancerprostate cancer on core needle biopsyrising psaProstate cancer; Gleason's score 3+4 prostate cancer; left nodules on digital rectal exam
Age decade807060505060705060607060
Path reportGross Description The specimen consists of multiple core fragments of tan soft tissue measuring 0.3cm to 1.8cm in length and 0.1cm in diameter. The specimen is submitted in six cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex. PROSTATE 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES AND 20% OF TOTAL TISSUE. PERINEURAL INVASION SEEN. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES AND 90% OF TOTAL TISSUE. PERINEURAL INVASION SEEN. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+4=8/10, INVOLVING ONE OF ONE CORE AND 95% OF TOTAL TISSUE. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING TWO OF MULTIPLE CORES AND 5% OF TOTAL TISSUE. PERINEURAL INVASION SEEN. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES AND 50% OF TOTAL TISSUE. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING ONE OF ONE CORE AND 20% OF TOTAL TISSUE. specimen is submitted entirely in six cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex.-rg 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING THREE OF MULTIPLE CORES, AND 15% OF TOTAL TISSUE. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING ONE OF TWO CORES, AND 5% OF TOTAL TISSUE. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ONE OF ONE CORE, AND 25% OF TOTAL TISSUE. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING THREE OF THREE CORES, AND 60% OF TOTAL TISSUE. PERINEURAL INVASION IS SEEN. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO OF TWO CORES, AND 70% OF TOTAL TISSUE. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING ONE OF ONE CORE, AND 60% OF TOTAL TISSUE. specimen is submitted entirely in six cassettes as follows: 1-right PZ, 2-right PZ/TZ, 3-right apex, 4-left PZ, 5-left PZ/TZ, 6-left apex. Final Diagnosis 1. RIGHT PZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. NOTE: IMMUNOHISTOCHEMISTRY STUDIES PERFORMED ON PARAFFIN EMBEDDED TISSUE BLOCK FOR PIN4 (RACEMASE/K309 AND P63) DID NOT REVEAL A STAINING PATTERN DIAGNOSTIC OF INVASIVE CARCINOMA. 2. RIGHT PZ/TZ: BENIGN PROSTATIC TISSUE WITH CHRONIC INFLAMMATION, NO TUMOR IDENTIFIED. 3. RIGHT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO CORES, ABOUT 60% OF THE TISSUE REPRESENTED. PERINEURAL INVASION IS PRESENT. 5. LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO CORES, ABOUT 70% OF THE TISSUE REPRESENTED. PERINEURAL INVASION IS PRESENT. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING TWO CORES, ABOUT 70% OF THE TISSUE REPRESENTED. PERINEURAL INVASION IS PRESENT. specimen consists of multiple brown/tan core biopsies measuring in length from 0.3 cm to 1.8 cm and 0.01 cm in diameter each. The specimen is submitted in toto in seven cassettes as follows: 1 right PZ, 2 right PZ/TZ, 3 right apex, 4 left PZ, 5 left PZ/TZ, 6 left apex, 7 - floater. PROSTATIC CORE NEEDLE BIOPSIES: 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (4+3) =7/10, PRESENT IN APPROXIMATELY 10% OF THE TISSUE SUBMITTED. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (4+4) =8/10, PRESENT IN APPROXIMATELY 10% OF THE TISSUE SUBMITTED. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (4+4) =8/10, PRESENT IN APPROXIMATELY 20% OF THE TISSUE SUBMITTED. 4. LEFT PZ: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. 5. LEFT PZ/TZ: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. 6. LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+4) =7/10, PRESENT IN APPROXIMATELY 10% OF THE TISSUE SUBMITTED. specimen consists of multiple brown/tan core biopsies measuring in length from 0.5 cm to 2.3 cm and 0.1 cm in diameter each. The specimen is submitted in toto in seven cassettes as follows: 1 right PZ, 2 right PZ/TZ, 3 right apex, 4 left PZ, 5 left PZ/TZ, 6 left apex PROSTATE BIOPSIES: 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 1 OF 1 CORE, AND 30% OF TOTAL TISSUE. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING 3 OF 3 CORES, AND 20% OF TOTAL TISSUE. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 1 OF 1 CORE, AND <5% OF TOTAL TISSUE. 4. LEFT PZ: BENIGN PROSTATIC TISSUE. 5. LEFT PZ/TZ: BENIGN PROSTATIC TISSUE. 6. LEFT APEX: BENIGN PROSTATIC TISSUE. 7. FLOATER: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 1 of 2 CORES, AND 20% OF TOTAL TISSUE. and 7 floater.Specimen consists of multiple brown/tan core biopsies measuring in length from 0.3 cm to 2 cm and 0.01 cm in diameter each. The specimen is submitted in toto in six cassettes as follows: 1 right PZ, 2 right PZ/TZ, 3 right apex, 4 left PZ, 5 left PZ/TZ, 6 left apex. Final Diagnosis PROSTATIC CORE NEEDLE BIOPSIES: 1. RIGHT PZ: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. 2. RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+4) =7/10, PRESENT IN APPROXIMATELY 30% OF THE TISSUE SUBMITTED. 3. RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE (3+3) =6/10, PRESENT IN LESS THAN 5% OF THE TISSUE SUBMITTED. 4. LEFT PZ: PROSTATIC TISSUE WITH MILD CHRONIC INFLAMMATION. NO TUMOR IDENTIFIED. 5. LEFT PZ/TZ: SINGLE MICROSCOPIC ATYPICAL GLANDULAR FOCUS. 6. LEFT APEX: SCANT PROSTATIC TISSUE. NO TUMOR IDENTIFIED. Radical prostatectomy Prostate Size: Weight: 51.4 g Size: 5X4.5X4.0cm Lymph Node Sampling Pelvic lymph node dissection Histologic Type : Adenocarcinoma (acinar, not otherwise specified) Histologic Grade Gleason Pattern Primary Pattern: Grade 3 Secondary Pattern: Grade 4 Total Gleason Score: 3+4=7/10 Tumor Quantitation: Proportion (percentage) of prostate involved by tumor: 20% Extraprostatic Extension: Present, focal (left anterior lobe at the base) Seminal Vesicle Invasion: Not identified Margins: Margins uninvolved by invasive carcinoma Treatment Effect on Carcinoma: Not identified Lymph-Vascular Invasion: Not identified Perineural Invasion: Present Pathologic Staging (pTNM): Primary Tumor (pT) pT3a Extraprostatic extension or microscopic invasion of bladder neck Regional Lymph Nodes (pN) pN0: No regional lymph node metastasis Specify: Number examined: 26 Number involved: 0 Distant Metastasis (pM) Not applicable Pathologic Staging pT3a pN0 pMx *Additional Pathologic Findings High-grade prostatic intraepithelial neoplasia (PIN) B. PORTION OF LEFT SEMINAL VESICLE: FIBROVASCULAR AND FIBROADPISE TISSUE. NO SEMINAL VESICLE TISSUE IDENTIFIED (ENTIRE SPECIMEN SUBMITTED FOR HISTOLOGICAL EXAMINATION) NO TUMOR IDENTIFIED. C. RIGHT EXTERNAL ILIAC LYMPH NODES: EIGHT (8) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. Addendum Diagnosis IMMUNOSTAIN FOR AE1/AE3 PERFORMED ON BLOCK C1 IS NEGATIVE. IMMUNOSTAIN FOR AE1/AE3 WILL BE EXAMINED AND RESULTS REPORTED IN AN ADDENDUM. D. RIGHT OBTURATOR LYMPH NODES: SEVEN (7) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. E. LEFT EXTERNAL ILIAC LYMPH NODES: FIVE (5) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. F. LEFT OBTURATOR LYMPH NODES: SIX (6) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. G. RIGHT SEMINAL VESICLE: SEMINAL VESICLE TISSUE. NO TUMOR IDENTIFIED. Addendum Diagnosis IMMUNOSTAIN FOR AE1/AE3 PERFORMED ON BLOCK C1 IS NEGATIVE. A: LEFT OBTURATOR LYMPH NODE POCKET B: RIGHT OBTURATOR LYMPH NODE POCKET C: PROSTATE AND SEMINAL VESICLES Final Diagnosis A. LEFT OBTURATOR LYMPH NODE POCKET: FOUR (4) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. B. RIGHT OBTURATOR LYMPH NODE POCKET: FOUR (4) REACTIVE LYMPH NODES, NO TUMOR IDENTIFIED. C. PROSTATE AND SEMINAL VESICLES: Procedure: Radical prostatectomy Prostate Size: 3.5x3x2.6cm Weight: 30.6g Lymph Node Sampling: Pelvic lymph node dissection Histologic Type: Adenocarcinoma (acinar, not otherwise specified) Histologic Grade: Gleason grade 3+3 score = 6/10 Primary pattern: Grade 3 Secondary pattern: Grade 3 Tumor Quantitation: Proportion (percentage) of prostate involved by tumor: 15% Extraprostatic Extension: Not identified Seminal Vesicle Invasion: Not identified Margins: Margins uninvolved by invasive carcinoma Treatment Effect on Carcinoma: Not identified Lymph-Vascular Invasion: Not identified Perineural Invasion: Present Additional Pathologic Findings: High-grade prostatic intraepithelial neoplasia (PIN) and chronic inflammation Pathologic Staging (pTNM) Primary Tumor (pT) pT2c: Bilateral disease Regional Lymph Nodes (pN) pN0: No regional lymph nodes metastasis Specify: Number examined: 8 Number involved: 0 Distant Metastasis (pM) Pathologic Stage: (pT2c, pN0) The specimen consists of multiple core fragments of tan soft tissue measuring 0.8cm to 1.5cm in length and 0.1cm in diameter. The specimen is submitted entirely in six cassettes. 1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex. PROSTATE: 1-RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+4=8/10, INVOLVING 50% OF THE TISSUE REPRESENTED. 2-RIGHT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING 80% OF THE TISSUE REPRESENTED. 3-RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4+3=7/10, INVOLVING 50% OF THE TISSUE REPRESENTED. 4-LEFT PZ: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. 5-LEFT PZ/TZ: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. 6-LEFT APEX: PROSTATIC TISSUE. NO TUMOR IDENTIFIED. Gross Description The specimen consists of multiple core fragments of tan soft tissue measuring 0.5cm to 2.3cm in length and 0.1cm in diameter. The specimen is submitted in six cassettes.1-right pz, 2-right pz/tz, 3-right apex, 4-left pz, 5-left pz/tz, 6-left apex. 1. RIGHT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING TWO CORES, ABOUT 20% OF TISSUE REPRESENTED. 2. RIGHT PZ/TZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 3. RIGHT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 4. LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING TWO CORES, ABOUT 30% OF TISSUE REPRESENTED. 5. LEFT PZ/TZ: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED. 6. LEFT APEX: BENIGN PROSTATIC TISSUE, NO TUMOR IDENTIFIED.Gross Description: The specimen consists of multiple core fragments of tan soft tissue measuring 1.4cm to 1.9cm in length and 0.1cm in circumference. The specimen is submitted entirely in six cassettes. PROSTATE: 1-RIGHT PZ: PROSTATE TISSUE WITH FOCAL CHRONIC INFLAMMATION. NO TUMOR IDENTIFIED. 2-RIGHT PZ/TZ: PROSTATIC ADENOCARCINOA, GLEASON SCORE 3+4+7/10, INVOLVING 25% OF THE TISSUE REPRESENTED. 3-RIGHT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 1% OF THE TISSUE REPRESENTED. 4-LEFT PZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING 60% OF THE TISSUE REPRESENTED. 5-LEFT PZ/TZ: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7/10, INVOLVING 70% OF THE TISSUE REPRESENTED. 6-LEFT APEX: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+3=6/10, INVOLVING 40% OF THE TISSUE REPRESENTED.
MRI reportProstate has a maximal lateral diameter of 5.2 cm, a maximal craniocaudal diameter of 3.6 cm and a maximal AP diameter of 2.8 cm resulting in an estimated gland volume of 27 cc. The zonal anatomy is preserved. In the mid third of the prostate, in the anterior aspect of the right paramedian central gland, at 11 o'clock, there is a irregular 13 x 14 mm area of suspicious enhancement, suggestive for malignancy (series 701 slice location 27-36). On the T2-W images the mass abuts the fibromuscular band and there is asymmetric bulging. There is also suspicious enhancement beyond the deviated fibromuscular band in this location. Beginning extraprostatic extension very likely. Series 501 slice location 33-36. The peripheral zones show no evidence of malignancy. No evidence for involvement of the neurovascular bundle on either side. The seminal vesicles and show diffuse low signal on the T2 weighted images; however the anatomy of the seminal vesicles with thin walls and regular vesicles seems to be preserved; there is no suspicious enhancement seen within the vesicles or within the walls. Therefore this T2 hypo intensity most likely caused by radiation. Seminal vesicles infiltration unlikely. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1) 1.4cm mass in the right anterior paramedian central gland, mid third of the prostate, as detailed above. Findings are highly suspicious for beginning extraprostatic extension (beyond the fibromuscular band) at 11 o'clock. 2) No evidence for involvement of the neurovascular bundle on either side. 3) No evidence of seminal vesicles infiltration. 4) No suspiciously enlarged obturator and iliac lymph nodes.prostate has a maximal lateral diameter of 5.2 cm, a maximal craniocaudal diameter of 5.2 cm and a maximal AP diameter of 3.0 cm resulting in an estimated gland volume of 42 cc. Status post TURP. Due to expected TURP changes the zonal anatomy not preserved. There is a bilateral tumor seen in the left and right posterior peripheral zone from with measuring in its max. extension approx. 4.0 x 2.0 cm (the dominant mass in the upper third/base from 4-8 o'clock) (Image 20 series 501). There is tumor extension involving midthird and apical third (all three levels are involved bilaterally). No evidence for involvement of the neurovascular bundle on either side. There is seminal vesicles infiltration (bilateral the seminal vesicle base is infiltrated (Images 22-24 series 501. Image 15 series 401). No manifest involvement of bladder neck (slightly obscured due to TURP changes. No involvement of rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1) Bilateral prostate cancer with seminal vesicles infiltration. 2) The dominant mass measures 4.0 x 2.0 cm, located in left and right posterior peripheral zones of the prostate base. The tumor extents from base, through midthird into the apex and infiltrates the seminal vesicles infiltration. 3) No manifest involvement of bladder neck (slightly obscured due to TURP changes). 4) No involvement of rectal wall. 5) No suspiciously enlarged obturator or iliac lymph nodes. 6) St. post TURP, with expected defect. prostate has a maximal lateral diameter of 4.1 cm, a maximal craniocaudal diameter of 3.7 cm and a maximal AP diameter of 2.6 cm resulting in an estimated gland volume of 21 cc. The zonal anatomy is preserved. There signs of chronic prostatitis bilaterally. In the right lobe, midthird peripheral zone at 8 o'clock there is a small area of irregular geographic T2 hypointensity with highly suspicious enhancement (rapid wash-in, rapid wash out) on dynamic contrast enhanced sequences compatible with tumor (series 501 image 10). In the left midthird to the apex peripheral zone, at 5 o'clock, there is a geographic region of T2 hypointensity with suspicious contrast enhancement (series 704 image 59). Tumor extends to the capsule bilaterally and there may be capsular infiltration between 7 o'clock and 5 o'clock. There is no manifest extracapsular tumor mass. No evidence for involvement of the neurovascular bundle on either side. Seminal vesicles are partially collapsed, which limits detection for tumor infiltration. There are slightly thickened walls. No discrete intraluminal tumor masses. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1. Bilateral prostate cancer. Right midthird peripheral zone 7 o'clock infiltrative tumor abutting the capsule. Left midthird to the apex peripheral zone, at 5 o'clock infiltrative tumor abutting the capsule. There is possible capsular infiltration between 7 o'clock and 5 o'clock. 2. No manifest extracapsular tumor mass or neurovascular bundle involvement. 3. Minimally filled seminal vesicles limiting evaluation for tumor infiltration, although there are no intraluminal tumor massesProstate measures 5.8 x 3.7 x 4.5 cm (estimated volume: 50 cc). There is a large mass seen predominantly on the left side involving the peripheral zone of the base, midthird and apex as well the central gland of the left (approx 50% of the gland are involved). The mass crosses the midline several times especially in midthird and apex and involves right peripheral zone and right central gland. The mass abuts the urethra in the apex, with signs of infiltration of the urethra. (series 501 slice location 15 image 6). Imaging findings are suggestive for extraprostatic disease at 1) the apex (median) , 2) at the left internal sphincter, with beginning involvement of the muscle, 3) anteriorly beyond the fibromuscular band at the apex and midthird and 4) at the level of midthird and apex the tumor (median and paramedian left) abuts the Denonvilliers fascia (series 501/slice location 21/ image 8). No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck. No suspiciously enlarged obturator and iliac lymph nodes. prostate has a maximal lateral diameter of 4.9 cm, a maximal craniocaudal diameter of 3.6 cm and a maximal AP diameter of 3.1 cm resulting in an estimated gland volume of 28 cc. The zonal anatomy is preserved. There is a background of chronic prostatitis. On the T2-weighted images, there is T2 hypointensity from apex to base involving the nearly the entire right peripheral zone. On dynamic contrast-enhanced sequences, there is highly suspicious early wash-in and rapid washout compatible with tumor, which extends to the capsule. At the mid-third level, posterior lateral right at 7 o'clock, there is minimal extracapsular disease with radial extension of up to 1 mm. (series 601, image 11), with possible beginning neurovascular involvement. On the left, the anterior aspect of the peripheral zone from the mid one-third to apical third, there is an area of T2 hypointensity. This region demonstrates highly suspicious contrast enhancement with peak wash in and a rapid wash out suspicious for tumor. This extends to the capsule and there is extracapsular invasion posterior lateral at 5 o'clock, without definite tumor extension beyond the "capsule" (series 601 image 10), at 4 o'clock. In the apex at 3 o'clock possible capsular infiltration without extraprostatic tumor masses. ( as annotated on PACS). No evidence for seminal vesicles infiltration. Seminal vesicles are thin-walled, with intraluminal fluid. No intraluminal masses. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1) Bilateral prostate cancer, with highly suspicion of extracapsular extension on the right, and possible beginning extraprostatic extension on the left. (Right peripheral zone infiltration from apex to base with extracapsular extension (radial extension 1 mm) and suspicion for neurovascular bundle involvement. Left anterior peripheral zone tumor from midthird to apical third with possible beginning extracapsular extension at midthird 5 o clock and apex 3 o'clock.) 2) No seminal vesicles involvement. 3) No pelvic lymphadenopathy. prostate has a maximal lateral diameter of 5.6 cm, a maximal craniocaudal diameter of 4.5 cm and a maximal AP diameter of 4.1 cm resulting in an estimated gland volume of 54 cc. The zonal anatomy is preserved. There is a 11 x 9 x 9 mm T2-hypo intense dominant mass seen in the right posterior lateral peripheral zone of prostate base and midthird. The mass shows suspicious enhancement, which is confined to the prostatic borders. The adjacent right neurovascular bundle is not involved. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. There is a prominent venous plexus. There is BPH. IMPRESSION: Right sided prostate cancer in the mid third and base of the prostate, with dominant nodule (11 x 9 x 9 mm) in the right posterior lateral peripheral zone. No evidence of extracapsular extension. There is a prominent venous plexus. prostate has a maximal lateral diameter of 4.8 cm, a maximal craniocaudal diameter of 3.8 cm and a maximal AP diameter of 3.2 cm resulting in an estimated gland volume of 30 cc. The zonal anatomy is preserved. There is a 1.5 x 0.9 cm T-2 W hypointense mass seen in the right posterior-lateral peripheral zone in the mid third of the prostate extending into the apex of the prostate, with suspicious enhancement (rapid wash in and out).This nodule abuts the capsule at the level of mid third and apical third, however there is no extraprostatic tumor or enhancement seen at that levels. At the right posterior lateral apex there asymmetric irregular T2-W hypointense tissue with suspicious enhancement seen, with indistinct borders to the surrounding fatty tissue: beginning extraprostatic extension right posterior lateral at the apex of the prostate possible. There are several small sub 5 mm areas of indeterminate enhancement seen in the left peripheral zone of the mid and upper third of the prostate, therefore multifocality possible, however the dominant nodule clearly on the right side, and these small areas could also represent chronic prostatitis. No evidence for involvement of the neurovascular bundle on either side. No definite seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. There are several up to 9 mm rounded lymph nodes seen on the iliac levels on both sides, beginning just above the obturator muscles up to the bifurcation. Some show a fatty hilum. IMPRESSION: 1) Right sided prostate cancer with the dominant nodule (1.5 x 0.9 cm) in the midthird and apical third of the prostate in the posterior lateral peripheral zone. Possible beginning extraprostatic extension at the posterior lateral right apex. Several up to 9 mm iliac lymph nodes bilateral, of unknown significance. No evidence of seminal vesicle infiltration or involvement of bladder neck or rectum. 2) BPH, Chronic prostatitis. prostate has a maximal lateral diameter of 4.8 cm, a maximal craniocaudal diameter of 4.3 cm and a maximal AP diameter of 2.2 cm resulting in an estimated gland volume of 25 cc. The zonal anatomy is preserved There is a T2-w hypointense nodule seen in the left base/midthird measuring 11 x 7 x 15 mm, in the posterior lateral peripheral zone at 4-6 o'clock. There is associated suspicious enhancement. This is highly suspicious for prostate cancer. The adjacent "capsule" shows also increased enhancement, which suggests capsular infiltration. No manifest tumor mass seen beyond the capsule. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. (bilateral <5 mm iliac lymph nodes) Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam. IMPRESSION: 1) 1.5 cm tumor in the left posterior lateral peripheral zone, with dominant nodule in base and midthird, with capsular infiltration, however, there are no manifest tumor masses beyond the capsule seen. 2) No evidence for right sided tumor. 3) No evidence of seminal vesicle infiltration or lymphadenopathy. prostate has a maximal lateral diameter of 4.6 cm, a maximal craniocaudal diameter of 3.7 cm and a maximal AP diameter of 2.2 cm resulting in an estimated gland volume of 20 cc. The zonal anatomy is preserved. In the midthird and apical third the prostate there are geographic areas of low signal on the T2-weighted images in the posterior aspects of the peripheral zones of both side between 5:00 and 8:00. The dominant area measures 18 x 6 mm and is located in the midthird paramedian right between 6 and 8:00 and extents into the apical third. This area shows also suspicious kinetics on the dynamic series.The area abuts the "pseudo-capsule" posterior and posterior lateral. However, there is NO evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes; several up to 7 x 4 mm obturator lymph nodes seen, on both sides. IMPRESSION: 1) Bilateral tumor, predominantly on the right within the posterior and posterior lateral peripheral zones between 5 and 8 o'clock, in mid third and apical third of the prostate, as detailed above (significant images are annotated on PACS). 2) No evidence of extraprostatic disease - specifically no evidence of extension into the neuro-vascular bundles of either side. prostate has a maximal lateral diameter of 4.5 cm, a maximal craniocaudal diameter of 4.2 cm and a maximal AP diameter of 2.8 cm resulting in an estimated gland volume of 28 cc. The zonal anatomy is preserved. In the mid third of the prostate, in the right posterior lateral peripheral zone between 6:00 and 10:00 there is a geographic 2.0 x 1.8 cm hypointense mass seen which shows rapid wash-in and washout on the dynamic series.(slice location 39; series 501; 401 and 701-709). There is bulging of the tumor at 8-10 o'clock towards the pubo-rectal sling, which seems not to be involved since there is a thin fatty line preserved between tumor and muscle. No manifest extraprostatic tumor mass seen. ("capsular infiltration" is likely). The right neuro vascular bundle seems not to be involved. The tumor extends to the apical and upper third of the prostate. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. Multiplanar reconstructions, subtraction images, and CAD analysis of the dynamic series for assessment of the kinetic information facilitated the interpretation of the exam;performed by radiologist. IMPRESSION: 2 cm bulging mass in the right posterior and lateral peripheral zone of the midthird of the prostate, with extension into the upper third and lower (apical third); with likely "capsular infiltration" in proximity to the right pubo-rectal sling (at level of mid third) , without manifest extracapsular extension. No evidence of neurovascular bundles involvement. No seminal vesicles infiltration.The prostate has a maximal lateral diameter of 4.7cm, a maximal craniocaudal diameter of 3.9cm and a maximal AP diameter of 2.7 cm resulting in an estimated gland volume of 26 cc. The zonal anatomy is preserved. The entire prostate shows on the T2-weighted images a diffuse fine linear and fine nodular hypointense signal alterations compatible with chronic prostatitis. Smallest foci (smaller than 4 mm) of cancer cannot be excluded. On the dynamic contrast-enhanced series there is a 1.7 x 0.7 cm area of suspicious wash-in and washout seen in the left peripheral zone between 9 and 6:00 in the prostate base and midthird. No evidence for involvement of the neurovascular bundle on either side. No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes. IMPRESSION: 1) 1.7 cm area of highly suspicious enhancement in the left posterior lateral (between 9-6 o clock) peripheral zone of the midthird and base of the prostate. 2) On the background of diffuse chronic prostatitis. Small foci of cancer on the right cannot be excluded (smaller than 4 mm). 3) No evidence of extraprostatic disease on either side. Unremarkable Seminal vesicles 4) No pelvic lymphadenopathy. The prostate has a maximal lateral diameter of 4.7 cm, a maximal craniocaudal diameter of 4.6 cm and a maximal AP diameter of 2.6 cm resulting in an estimated gland volume of 29 cc. The zonal anatomy is preserved. There is T2-hypointense signal seen in the posterior and posterior lateral peripheral zone, mid third and apical third, bilateral.(more on the left). Largest dominant nodule on the left is 11 x 13 mm at 5 o'clock apical peripheral zone; the largest dominant nodule on the right is seen in at 8 o'clock mid third of the prostate (also peripheral zone) measuring 7 x 6 mm. These areas show suspicious enhancement curves on the dynamic series. No evidence for involvement of the neurovascular bundle on either side.No evidence for seminal vesicles infiltration. No evidence of involvement of bladder neck and rectal wall. No suspiciously enlarged obturator and iliac lymph nodes.IMPRESSION: Bilateral (left more than right) prostate cancer in the midthird and apical third of the prostate within the peripheral zones. No MRI evidence of extraprostatic extension.