8. The People's Prostate

Question 1

Prostatic adenoCA is commonly seen in what zone?

Answer 1

Question 2

Central zone + Transitional zone =

Answer 2

Central gland

Question 3

The most T2 bright zone

Answer 3

Peripheral zone

Question 4

The prostate anatomy

Answer 4

Question 5

The difference between the dark and bright stuff!

Answer 5

Question 6

Picture of Prostate CA on MRI

Answer 6

Dark T2
+ Restricted diffusion (low ADC)
+ enhances early and washes out

Question 7

How do you evaluate prostate mets?

Answer 7

Bone scan (Vertebral body)

Question 8

Prostate cancer staging

Answer 8

Question 9

Most important factor in staging

Answer 9

Extra capsular extension

Question 10

Stage II vs Stage III Prostate CA

Answer 10

Question 11

What is behind the prostate that can get invaded?

Answer 11

Seminal vesicles (T3b) and the. nerve bundle

Question 12

Who Dies of Prostate Cancer ?

Answer 12

3 factors:

1. Gleason Score 8-10
2. Advanced Clincal stagen (mets)
3. PSA > 20

Gleason scores less than 6, PSA < 10, and staging < 2a (less than half
the lobe) are unlikely to die of the prostate cancer.

Question 13

Clinically Significant Cancer:

Answer 13

Gleason Score > 7
Cancer volume > 0.5 cc
Capsular extension

Question 14

Capsular extension picture

Answer 14

Loss of normal T2 signal in the seminal vesicle
Bulging of the capsule
Loss of fat betwee prostate and rectum
Neurovascular bundle asymmetry

Question 15

This is an antigen produced by the normal prostate and incorporated into the ejaculate for the purpose of dissolving cervical mucus etc

Answer 15

PSA

Normal < 4
Low Risk Category < 10
High Risk Category > 20.

Question 16

Normal PSA after prostatectomy

Answer 16

0

If > 0.2 think recurrence

Post radiation = 2.0? = concerning for recurrence

< 20 = bone mets unlikely

Question 17

The gleason score

Answer 17

Gleason score
The Gleason score is used by pathologists to grade prostate cancers.
If the cancer cells and their growth patterns look very abnormal, a grade 5 is assigned. The Gleason score is the sum of the two most prevalent patterns.
These 2 grades are added to yield the Gleason score.

The highest Gleason score therefore is 10.
For example, if the Gleason score is written as 3+4=7, it means that most of the tumor is grade 3 and the second most common or most malignant grade is 4.

Question 18

Tumor in the Transition zone is determined primarily from>

Answer 18

T2. (T for T)

Question 19

Peripheral zone is determined primarily from

Answer 19

DWI

Question 20

PZ-DWI = Linear/Wedge

Answer 20

PI-RADS 2

Question 21

PZ-DWI = Vague Patchy

Answer 21

PI-RADS 3

Question 22

PZ-DWI = Focal < 1.5 cm

Answer 22

PI-RADS 4

Question 23

PZ-DWI = Vague Patchy + Enhancment

Answer 23

PI-RADS 4

Question 24

TZ-T2 = Atypical Nodule - no capsule

Answer 24

PI-RADS 2

Question 25

PZ-DWI = Focal > 1.5 cm or with extracapsular extension

Answer 25

PI-RADS 5

Question 26

TZ-T2 = Atypical Nodule - no capsule + Focal Restricted DWI

Answer 26

PI-RADS 3

Question 27

TZ-T2 = Heterogeneous, blurry margins

Answer 27

PI-RADS 3

Question 28

TZ-T2 = Heterogeneous, blurry margins + Restricted DWI < 1.5

Answer 28

PI-RADS 4

Question 29

TZ-T2 = Low Signal < 1.5 cm)

Answer 29

PI-RADS 4

Question 30

TZ-T2 = Low Signal > 1.5 or with extracapsular extension

Answer 30

PI-RADS 5

Question 31

Benign Prostatic Hyperplasaia (BPH) commonly invovles what zone?

Answer 31

Transitional Zone (Cancer is rare in transitional zone - 10%)

Question 32

What hyperterophies in BPH and sticks up to the bladder?

Answer 32

Median Lobe

Question 33

Answer 33

Benign Prostatic Hyperplasia

“J shaped”, “Fishhook”, or “Hockey stick” shaped ureter - as the distal ureter curves around the enlarged prostate

Question 34

Answer 34

Benign prostatic Hyperplasia

Question 35

Answer 35

Benign prostatic Hyperplasia

In the Transitional Zone (Central Gland)
T2 Heterogenous
Can Restrict Diffusion
May enhance and washout

Question 36

PZ + Dark T2 + Dark ADC (Restricted Diffusion) + Early enhancment and early washout =

Answer 36

Peripheral zone tumor

Question 37

PZ + Dark D2/Bright T1 + Dark ADC (Resticted diffusion) =

Answer 37

Peripheral zone hemorrhage

Question 38

TZ + Dark “Charcoal” T2 + Dark ADC + Early enhancement and early washout =

Answer 38

Central gland / Transition zone Tumor

Question 39

TZ + Dark “Well-defined” T2 + Less darck ADC + Can enhance =

Answer 39

BPH