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Core > Reproductive: Prostate > Flashcards

Reproductive: Prostate Flashcards

1
Q

Brown area

A

Fibromuscular zone

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2
Q

Yellow area

A

Peripheral zone

Note: This is where most prostate cancers are found.

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3
Q

Blue area

A

Central zone

Note: Don’t confuse this with the “central gland” which refers to the central and transitional zones together.

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4
Q

Green area

A

Transition zone

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5
Q

The blue and green areas are collectively referred to as…

A

The central gland

Note: Don’t confuse this with the central zone, which is just the blue area.

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6
Q

Which prostate zone is the most T2 bright?

A

The peripheral zone

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7
Q

What is the most common location of prostate adenocarcinoma?

A

The peripheral zone (70%)

Note: Followed by transition zone (20%) and central zone (10%).

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8
Q

What is the most common location for BPH nodules?

A

The central gland (central and transitional zones)

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9
Q

Where is the apex of the prostate?

A

The inferior tip (mostly peripheral zone)

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10
Q

MRI features of prostate cancer

A
  • T2 dark mass in peripheral zone (T2 bright background)
  • Restricted diffusion
  • Type 3 enhancement (early enhancement with washout)
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11
Q

If ______, then prostate cancer has probably not metastasized to bone

A

PSA < 20

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12
Q

What imaging study is usually used to look for prostate metastases?

A

Bone scan

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13
Q
A

Think prostate cancer

Note: T2 dark mass in the peripheral zone.

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14
Q
A

Prostate cancer

Note: Restricted diffusion in a T2 dark mass in the peripheral zone.

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15
Q

What is the most important imaging feature in determining treatment for prostate cancer?

A

Mass extension through the prostate capsule (on imaging, appears as a focal bulging of the capsule or frank extension through it)

Note: This upgrades the cancer from stage 2 to stage 3.

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16
Q

What defines stage 3 prostate cancer?

A

Cancer extension through the prostate capsule

Note: Once through the prostate capsule, cancer can then invade the seminal vesicles, nerve bundle, etc.

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17
Q

What are signs of prostate cancer extension through the prostate capsule (i.e. stage 3 disease)?

A
  • Bulging of the capsule (or frank invasion)
  • Loss of the fat plane between the prostate and rectum
  • Neuromuscular bundle asymmetry
  • Loss of the normal T2 bright signal in a seminal vesicle
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18
Q

What features suggest that a prostate cancer is clinically significant/worrying?

A
  • Gleason score of 8 or higher
  • Cancer volume > 0.5 mL
  • Cancer extension through the prostate capsule (stage 3 disease)

Note: Prostate cancers with Gleason scores < 6 and PSA < 10 may be clinically insignificant (a lot of incidental prostate cancers were found when we started screening with PSA).

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19
Q

Normal PSA level

A

Normal: <4
Low risk: 4-10
High risk: >20

20
Q

Normal PSA level s/p prostatectomy

A

0

Note: If PSA is 0.2 in a pt s/p prostatectomy, think recurrence of prostate cancer.

21
Q

Normal PSA level s/p radiation for prostate cancer

A

<2

Note: Anything over 2 is concerning for prostate cancer recurrence.

22
Q

Gleason score vs grade vs group

A

Gleason grade is the histological pattern for each of the, usually 12, biopsies (ranging from 1 to 5)

Gleason score (the sum of the two most common Gleason grades, e.g. 3+5 = 8)

Gleason group (categories synthesizing Gleason grades and scores to reflect actual risk)

23
Q

Which Gleason score is worse: 3+5 or 5+3 (Note: Both have a Gleason score of 8)

A

5+3 is worse (the first number is the more common biopsy result, so 5+3 has more grade 5 histology than 3+5)

24
Q

What images are used to assign a PI-RADS score?

A
  • Diffusion weighted imaging
  • T2
  • Enhancement
25
Q

Which MRI sequence is most important for assigning a PI-RADS score to a tumor in the peripheral zone?

A

Diffusion weighted imaging

26
Q

Which MRI sequence is most important for assigning a PI-RADS score to a tumor in the transition zone?

A

T2

Note: T2 for Transition zone.

27
Q

What are the possible baseline PI-RADS scores for a peripheral zone tumor?

A

1: normal
2: linear/wedge restricted diffusion
3: Mildly hypointense on ADC
4: Markedly hypointense on ADC and <1.5 cm hyperintense on diffusion
5: >1.5 cm hyperintense on diffusion

28
Q

What are the possible baseline PI-RADS scores for a transition zone tumor?

A

1: Normal nodules (with full capsule)
2: Atypical nodules (e.g. no capsule)
3: Heterogeneous nodule or blurry margins
4: Homogenously T2 hypointense and < 1.5 cm
5: Homogenously T2 hypointense and > 1.5 cm OR with extra capsular extension

29
Q

How does enhancement of a vague patch of restricted diffusion in the peripheral zone change the PI-RADS score?

A

Enhancement increases a vague patch of restricted diffusion from PI-RADS 3 to PI-RADS 4

30
Q

How does focal restricted diffusion of an atypical nodule in the transition zone change the PI-RADS score?

A

Focal restricted diffusion increases an atypical nodule in the transition zone from PI-RADS 2 to PI-RADS 3

31
Q

How does restricted diffusion with diffusion hyperintensity > 1.5 cm in a T2 heterogenous/blurry lesion in the transition zone change the PI-RADS score?

A

> 1.5 cm diffusion hyperintensity increases a T2 heterogeneous/blurry lesion in the transition zone from PI-RADS 3 to PI-RADS 4

32
Q

PI-RADS

A

PI-RADS 1 (normal)

33
Q

PI-RADS

A

PI-RADS 2 (indistinct hypointensity on ADC)

34
Q

PI-RADS

A

PI-RADS 3 (focal mild restricted diffusion)

35
Q

PI-RADS

A

PI-RADS 4 (marked focal restricted diffusion < 1.5 cm)

36
Q

PI-RADS

A

PI-RADS 5 (marked focal restricted diffusion measuring > 1.5 cm on diffusion)

37
Q

PI-RADS

A

PI-RADS 1 (normal)

38
Q

PI-RADS

A

PI-RADS 2 (circumscribed T2 hypointense or heterogeneous nodule)

39
Q

PI-RADS

A

PI-RADS 3 (T2 heterogeneous nodule with obscured margins)

40
Q

PI-RADS

A

PI-RADS 4 (non-circumscribed T2 hypointense mass < 1.5 cm)

41
Q

PI-RADS

A

PI-RADS 5 (non-circumscribed T2 hypointense mass > 1.5 cm OR extra-prostatic extension)

42
Q

What is the most commonly used definition of benign prostatic hyperplasia?

A

Prostate volume of 30 mL or more

43
Q

Which portion of the prostate enlarges the most in benign prostatic hyperplasia?

A

The transition zone

Note: Cancers are less common here (20%).

44
Q

Which portion of the prostate can hypertrophy inn BPH and protrude into the bladder lumen?

A

The median lobe

45
Q
A

Fish-hook configuration of the distal ureter, suggestive of bladder outlet obstruction due to BPH

Note: The distal ureter looks like a fish-hook because it is curving around a hypertrophied prostate.

46
Q

Common MRI characteristics of benign BPH nodules

A
  • T2 heterogeneous
  • +/- restricted diffusion
  • +/- enhancement
47
Q

S/p prostate biopsy

A

Post biopsy hemorrhage in the right peripheral zone

Note: T1 bright signal.

Core (98 decks)

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