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adenocarcinoma

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Prostate Cancer

umar - Sat, 12/06/2014 - 15:26

The prostate gland is enlarged. The central gland is enlarged, and has a lobulated contour with associated cystic change compatible with benign prostatic hypertrophy. On the diffusion weighted images, there is an irregularly shaped area of diffusion restriction involving the right lateral base. It also involves both the peripheral zone and transitional zone. This area roughly corresponds to a region of marked T2 hypointensity on the T2 weighted images, although its margins are poorly defined on the T2 images given that the majority of the peripheral zone is abnormally T2 hypointense.

Authors & Contributors: 
Umar Tariq
Age: 
60-69
Sex: 
Male
History: 
64-year-old male with biopsy proven prostate adenocarcinoma on the right.
Associated Images: 
Irregular loss of peripheral bright T2 in prostateSeminal vesicle involvementRight lateral base of Prostate showing contrast enhancement and does not wash out.showing diffusion restriction corresponding to the area of involvement seen on other imagesT1 brightness on left base of prostate representing hemorrhage.T1 brightness on left base of prostate representing hemorrhage.T1 brightness on left base of prostate representing hemorrhage.T1 brightness on left base of prostate representing hemorrhage.T1 brightness on left base of prostate representing hemorrhage.T1 brightness on left base of prostate representing hemorrhage.
Differential Diagnosis: 
1. Benign Prostatic Hypertrophy (BPH) 2. Bladder Carcinoma
Diagnosis: 
Biopsy proven Prostate Adenocarcinoma
Path Proven: 
Yes
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

 

Teaching Point: 
Low signal intensity on T2 weighted images in the peripheral zone of prostate is highly suggestive of prostate carcinoma.
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Keywords:
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