Newly Diagnosed

I did an MRI today at Hopkins as part of the AS and my follow up appointment is Monday 28th. Here is the result below. I will appreciate if anyone can help interpret it. My Psa keeps going up and down, 3.81 in January, and 4.7 last week.

Impression
IMPRESSION:
Enlarged BPH gland with a solitary left-sided peripheral zone lesion. No findings of extraprostatic disease.

Features of chronic bladder outlet obstruction with trabeculations

Small volume of free fluid in the pelvis, nonspecific

Dominant nodule lesion #1, overall PI-RADS = 2/5

Overall Assessment Categories (PI-RADS V2):
Likelihood that a clinically significant cancer is present based on MRI parameters
1. Very low (clinically significant cancer is highly unlikely to be present)
2. Low (clinically significant cancer is unlikely to be present)
3. Intermediate (the presence of clinically significant cancer is equivocal)
4. High (clinically significant cancer is likely to be present)
5. Very high (clinically significant cancer is highly likely to be present)

Images and interpretation personally reviewed by: William D. Craig, MD,MBA

Narrative
EXAM: MRI PROSTATE W/WO CONTRAST

INDICATION: prostate cancer surveillance
PSA 4.7
Prior biopsy: Potential focus of neoplasia. No Gleason score given.

COMPARISON: None.

TECHNIQUE:
Imaging at 3 Tesla.
Coil: Body Matrix coil
Sequences: Large field of view images of the pelvis were obtained: axial T2 weighted with fat suppression, 3D T2 weighted, and axial T1 weighted with fat suppression after contrast administration. Small field of view imaging of the prostate was performed
with axial, sagittal, and coronal T2 weighted imaging. Diffusion weighted imaging (DWI) was performed with apparent diffusion coefficient (ADC) mapping. Axial T1 weighted imaging pre-contrast and dynamic contrast enhanced (DCE) imaging was performed
following injection of 0.1 mmol/kg gadolinium IV.

FINDINGS:

IMAGE QUALITY: Diagnostic.

HEMORRHAGE:
No areas of high T1 signal suggesting hemorrhage.

PROSTATE VOLUME:
Prostate measures: 6.1 cm TV x 3.9 cm AP x 6.1 cm CC, volume 76 cc.

PERIPHERAL ZONE:
Some faint patchy areas of decreased T2 signal with a solitary measurable focus

Lesion #1:
- Side: left
- Level: base
- Zone: peripheral zone
- Location: posterior
- Diagram - sector: PZpm
- Size: 6 mm on T2-weighted imaging
- Relation to capsule: does not abut capsule
- Series 501 Image 15

Assessment categories:
- T2 = 4/5
- DWI-ADC = 2/5
- DCE = negative
- Overall PI-RADS = 2/5

TRANSITION ZONE:
Moderate hypertrophy with heterogeneous T2-signal with a prominent median lobe creating mass effect upon the bladder base. No worrisome nodule/lesion seen.

SEMINAL VESICLES: Normal, symmetric.

NEUROVASCULAR BUNDLES: Normal, symmetric.

BLADDER NECK: Normal

MEMBRANOUS URETHRA: Normal

LYMPH NODES: None enlarged.

BONE MARROW: Normal signal intensity.

OTHER: Trabeculated bladder wall.

Small amount of free fluid, indeterminate.

Component Results
There is no component information for this result.