Presentation
Elevated PSA. Prostate biopsy 8 weeks prior. Index imaging.
Patient Data
Imaging degraded by hemorrhage.
Multifocal disease in both sides displaying restricted diffusion.
No extra-prostatic disease.
Area in peripheral zone demonstrating lack of signal on T1w (absence of blood products), low T2w, and restricted diffusion.
Case Discussion
Histology
Multiple bilateral core biopsies. Adenocarcinoma in all cores. Highest Gleason score 3+4=7.
Comment
In early post-biopsy prostate imaging, hemorrhage can degrade image quality (with T1w hyperintensities). The matter of timing is contentious, especially if imaging will steer treatment options.
In some cases, abnormal prostate tissue will not produce normal levels of citrate, an endogenous anticoagulant, which results in areas with less blood product than expected. This "hemorrhage exclusion sign", in conjunction T2w and DWI findings can help identify tumors.
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