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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.