DETECTING PROSTATE CANCER​ AT A LATE STAGE FROM AN ABNORMAL PSA LEVEL​ WITH PELVIC MRI SCAN AT CAREPLUS​

Mr. H.B.W (65 years old), previously healthy, reported no urinary symptoms such as hesitancy, dysuria, or hematuria. Over the past six months, he experienced only mild, dull pain in the lower back and pelvis, occasionally accompanied by hip discomfort when standing for long periods, which he assumed was age-related spinal degeneration. 

During a routine health check-up, his physician noted an abnormally elevated PSA (Prostate-Specific Antigen) level of 85 ng/mL, compared to 6 ng/mL two years earlier. The rapid and markedly elevated PSA raised strong suspicion of advanced prostate cancer. A pelvic MRI was recommended to assess the prostate gland and surrounding structures in detail. 

IMAGING ASSESSMENT: PELVIC MRI FOR PROSTATE EVALUATION 

MRI is currently considered the most accurate imaging modality for evaluating prostate lesions, especially when correlated with PSA levels. 

The pelvic MRI findings for patient H.B.W revealed: 

• Prostate size: approximately 4.6 × 3.9 × 3.7 cm (transverse × anteroposterior × craniocaudal). 
• A space-occupying lesion was identified in the peripheral zone (left), measuring approximately 3.6 × 3.4 cm, with poorly defined margins and irregular borders. 
• The lesion demonstrated low signal on T1W and T2W, high signal on DWI, low signal on ADC, and marked heterogeneous enhancement. 
• The lesion extended beyond the prostatic capsule and infiltrated both seminal vesicles, more prominent on the left. 
• Pelvic lymph nodes: enlarged with abnormal signal characteristics — suggestive of nodal metastasis. 
• Skeletal involvement: multiple suspicious lesions in the pelvic bones and spine — suggestive of bone metastases. 

THE VALUE OF PSA AND PROSTATE MRI 

PSA (Prostate-Specific Antigen) is a prostate-specific biomarker that helps detect abnormalities even in asymptomatic patients. 

• Normal PSA: <4 ng/mL 
• PSA 4–10 ng/mL: borderline (“gray zone”) — requires follow-up 
• PSA >10 ng/mL: high suspicion for malignancy 

In Mr. H.’s case, a more than tenfold increase within two years was a clear warning sign requiring urgent evaluation. 

However, PSA alone is only an “alert signal.” 

MRI plays a central role in: 

• Distinguishing malignant from benign lesions based on tissue characteristics 
• Assessing extracapsular extension, seminal vesicle invasion, and pelvic lymphadenopathy 
• Guiding targeted biopsy to improve histopathologic accuracy 
• Detecting early bone or nodal metastasis when disease has spread beyond the prostate 

With both an abnormally high PSA and MRI findings consistent with PI-RADS 5, clinicians were able to rapidly confirm advanced prostate cancer with metastasis. 

DISCUSSION 

Prostate cancer often progresses silently, with minimal symptoms in its early stages. Therefore, routine health check-ups and PSA monitoring are key to early detection. 

When PSA is abnormally elevated, prostate MRI is the essential next step because it enables clinicians to: 

• Characterize the nature of the lesion 
• Accurately stage the disease 
• Develop an optimal treatment plan 

Early detection significantly improves patient prognosis. In contrast, late-stage detection with metastasis shifts treatment goals toward disease control and symptom relief rather than cure. 

CONCLUSION 

The case of Mr. H.B.W highlights the critical importance of routine health screening and PSA monitoring in men over 50 years of age. 

Timely recognition of an abnormal PSA level and appropriate use of prostate MRI enabled accurate diagnosis and comprehensive staging, paving the way for an appropriate management strategy.