Recurrent Prostate Cancer
History
Age
Sex
Path Proven
Findings
There is an avidly enhancing mass in the region of the prostatectomy bed, consistent with recurrent prostate adenocarcinoma. This abnormally enhancing soft tissue transgresses the anterior rectal wall at the 11 o'clock position, consistent with local invasion. There is invasion of the right puborectalis muscle, anterior wall of rectum and base of the bladder. The mass appears to invade through the entire thickness of the posterior bladder wall.
Differential Diagnosis
Diagnosis
Discussion
Prostate cancer mostly occurs in the peripheral zone of prostate. It is mostly asymptomatic with abnormal digital rectal exam but can present with symptoms similar to BPH like hesitancy, urgency, increased frequency; there can be bone pain due to osteoblastic metastases to vertebrae. It can result into bladder outlet obstruction, obstructive uropathy, uremia and pathological fractures. There can be elevated PSA but it not specific for prostate cancer; PSA velocity is a more specific test. It appears as diffuse low signal intensity on T1 weighted images and low signal on T2 weighted images in the peripheral zone. Moreover there is restricted diffusion in diffusion-weighted images. If there is a hemorrhage because of a recent biopsy, it would appear with increased signal on T1 pre-contrast images. Obliteration of rectoprostatic angle suggest extracapsular extension.
Staging
A and T1: Clinically localized (tumor not palpable on digital rectal exam)
B and T2: Confined to prostate
B1 and T2a: Tumor involves < 1/2 of 1 lobe
B2 and T2b: Tumor involves > 1/2 of 1 lobe
B2 and T2c: Tumor involves both lobes
C and T3: Locally invasive beyond prostatic capsule
C1 and T3a: Unilateral or bilateral extracapsular extension
C1 and T3b: Seminal vesicle invasion
C2: Extracapsular extension producing bladder outlet or ureteral obstruction
T4: Invades adjacent tissuesBladder, rectum, levator ani, pelvic sidewall
D and N/M: Lymph node and distant metastases to bones, lung, liver, and brain
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