Download Prostate lesion on CT - Society of Abdominal Radiology

Younger Male with Large Prostate
Tumor on CT with MRI Correlation
Steven Eberhardt, MD
and
Martha Terrazas, MD (PGY4)
Department of Radiology
University of New Mexico
History
• 49 year old male who presented from an
outside hospital with clinical history of
adenocarcinoma of the prostate, Gleason 3+4
= 7 (biopsy proven). Reported PSA of 4.5. No
prior imaging was available.
• Bone scan was performed to evaluate for
metastatic osseous disease.
Bone scan findings:
• Focal uptake in the right acetabulum, consistent with
metastatic osseous disease.
• CT of the abdomen and pelvis was performed to
evaluate for metastatic disease.
CT Findings:
• Asymmetric increased masslike enhancement
on R side of gland, suspect for cancer.
CT Findings:
• Right internal iliac lymph node is somewhat
suspicious given borderline size.
• No bony lesions identified on CT.
MRI was then performed for staging
• Exam was performed on a 3.0 T MRI scanner
without an endorectal coil.
• At the time of the exam, protocol for 3.0 T did
not include routine diffusion weighted images.
Prostate MR Findings:
• Large locally advanced tumor involving the entire right side of the gland,
anterior and posteriorly from the base to the apex, with extension to the
central part of the gland including the periurethral tissue.
• Evidence of gross extraglandular extension and early/small volume right
seminal vesicle invasion at the base.
Prostate MR Findings:
• Borderline sized right internal iliac node, with strong
enhancement, suspect for metastatic disease.
Prostate MRI Findings, Continued:
• T1-pre and post contrast sequences demonstrate a focal
marrow lesion, consistent with metastatic disease.
Treatment
• Patient was treated for metastatic prostate
cancer with hormonal therapy.
• In 3 months the patient’s PSA decreased to
3.0.
Teaching points
• Some prostate cancers in the appropriate clinical
circumstances may be recognized on CT as a high attenuation
enhancing mass.
• MRI during staging in high risk patients can result in altered
management plan by identifying suspicious lymph nodes and
osseous metastatic lesions, and presence of locally advanced
disease for surgical planning when metastatic disease is not
present.
• Younger men are more prone to have aggressive prostate
cancers, sometimes with lower PSA than expected for extent
of disease, as in this case.