Figuring out T stage with limited imaging

This 87-year-old man presents with two cancers. Note they are unrelated and not the result of one cancer spreading to another organ. What are the two cancers? Advanced questions: Can you posit the T stage of cancer #1 from limited imaging? How valuable is diffusion imaging in the prostate as an example?

Answer: Prostate and rectal cancer. You can posit the T stage of the prostate lesion on the left (arrow) as T3b as there is seminal vesicle invasion. The diffusion image is especially valuable for mass-like lesions over 3 millimeters in size in the prostate peripheral zone. Many “benign’ or nonaggressive central zone masses in the prostate will have mild diffusion restriction. For more prostate staging resources, visit MRI Online.

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