MRI report

I got the full copy of hubby’s MRI report. Now we are anxiously waiting for the biopsy results. Hopefully by the end of the week.

Study Result

Impression


Highly suspicious cancer foci noted in the peripheral zones bilaterally, with possible extracapsular extension and neurovascular bundle invasion on the left as well as possible extracapsular extension on the right.
Narrative


FULL RESULT:

Examination: MRI PELVIS W WO CONTRAST PROSTATE on 3/15/2020 1:51 PM

Comparison prostate MRI: None.

PSA: 6.4 ng/mL on 12/16/2019.

Gleason score: 3+3 = 6.

Indication: Prostate cancer staging.

Technique: Prostate MRI with endorectal coil acquired at 1.5T. Three-plane localizer, axial T1W FSPGR, and axial DWI of the pelvis was performed. With an endorectal coil, three plane T2WI, axial DWI with ADC reconstruction and DCE sequences were performed focused on the prostate.

Findings:

Prostate measurement (3-plane): 5.2 x 4.2 x 5.5 cm (transverse by AP by craniocaudal).

Hemorrhage: Absent

Benign prostatic hypertrophy: Present in the central gland

Dominant lesion measures 1.2 cm and is located in the left peripheral zone at the level of the base on:
Image # 19, series 7.
location: 4-5 o'clock
Exhibiting low T2 signal
ADC signal is low
Qualitative suspicion of clinically significant disease: 4.

Extra-prostatic extension (EPE): Possible

Neurovascular bundle invasion (NVI): There is a suggestion of neurovascular bundle invasion.

Seminal vesicle invasion (SVI): Absent

Another focus is noted measuring 1.4 cm and is located in the right at the level of the mid gland on:
Image # 20, series 7.
location: 9 o'clock
Exhibiting low T2 signal
ADC signal is low
Qualitative suspicion of clinically significant disease: 4.There is a possible extracapsular extension, indicated by capsular bulge, without definite evidence of neurovascular bundle invasion.

No clear involvement of the bladder neck, distal sphincter, or rectum.

Lymphadenopathy: No definite evidence of lymphadenopathy.

Bone metastasis: No definite evidence of osseous metastases in the pelvis.

Hi Star,

OK, it sounds like he's got 2 tumors (not unusual, PC is usually multi-focal), one in the peripheral zone that likely has escaped the capsule and is possibly invading the nerve on one side. The other is in the center, and is protruding a little.

Good news is, no evidence of anything outside the immediate gland area. Nothing in the pelvis, lymph nodes, etc.

We will see what the second biopsy says.

That being said, even if the G6 diagnosis holds, he probably needs treatment. And, I would think that something like SBRT would be great for him. It poses less risk to the nerves (lower chance of ED) and can be calibrated to hit a slightly wider area than the gland itself and so take care of any little beasties that have escaped into the pelvic bed.

With the nerve involvement, surgery would probably guarantee significant ED and with the tumor on the edge of the peripheral zone, chances of bad incontinence goes up with surgery.

It does look like the answers are coming. Hang in there.

These were the findings on the after biopsy hospital summary. Not pathology...just notes.

FINDINGS
Findings At Operation:
TRUS Estimated Prostate Volume.......42 cc MRI Estimated Prostate Volume..........35 cc
1. ROI #1, 0.14 mL, left lateral base, medium risk.
2. ROI #2, 0.55 mL, right lateral mid, high risk, central zone was associated with a hypoechoic region.
3. ROI #3, 0.1 mL, right medial apex, low risk.
Specimens:
15 prostate biopsies, including 7 targeted biopsies of 3 regions of interest and 8 random systematic biopsies from areas away from the regions of interest.