This is for the surgically naive prostate. Click here for post-treatment cases with biochemical recurrance (BCE).
DWI / ADC are the dominant sequences for Peripheral Zone (PZ) lesions.
Is there a focal dark area on ADC?
Was DWI focal and brighter than other areas (non-lesions) in the prostate?
This is at least a PI-RADS 4.
Any of the following present?
PI-RADS 4, Suspicious. Biopsy is recommended.
PI-RADS 5, Highly Suspicious. Biopsy is recommended.
Was there early contrast enhancement?
Early is with 10 seconds of the femoral artery or before the rest of the prostate.
PI-RADS 3, Intermediate (the presence of clinically significant cancer is equivocal). You had a peripheral zone lesion that was focally dark on ADC but only iso-intense to other / normal areas within the peripheral zone. Negative DCE.
PI-RADS 4, Suspicious. Biopsy is recommended. DWI score was 3 but bumped up to PI-RADS 4 because of the positive DCE.
Peripheral zone lesion that was focally dark on ADC but only iso-intense to other / normal areas within the peripheral zone.
PI-RADS 2, Benign. You had a peripheral zone lesion on T2 but no corresponding focal abnormality on ADC.
T2 is the dmoinant sequence for Transitional Zone (TZ) lesions.
On T2, is the lesion "encapsulated" with clearly defined margins? If so, that would be a benign BPH nodule.
PI-RADS 2, Benign. You had a transitional zone lesion on T2 with classic features of a benign BPH nodule. DWI / ADW and contrast enhancement are all irrelevant.
Homogeneous and Hypo-intense with a lenticular or "water drop" shape?
Also click yes if the lesion involves the AFMS (Anterior Fibro-Muscular Stroma) or the Urethral Sphincter.
DWI Score of 5? (ADC dark with bright DWI measuring larger that 1.5 cm)
PI-RADS 3, Intermediate (the presence of clinically significant cancer is equivocal). You had a transitional zone lesion with ill defined margins that was not lenticular, homogeneous or hypo-intense. DWI score < 5.
PI-RADS 4, Suspicious. Biopsy is recommended. Score by T2 was 3 but the DWI score of 5 bumped the PI-RADS total score to 4.
Larger than 1.5 cm or ECE (Extra-Capsular Extension)?
PI-RADS 4, Suspicious. Biopsy is recommended.
PI-RADS 5, Highly Suspicious. Biopsy is recommended.