The patient was initially referred to hematology due to the pancytopenia, the CT was performed as part of the diagnostic workup.

Prostate specific antigen (PSA) was approximately 1600 micrograms/L at baseline.

The patient proceeded to bone marrow biopsy under hematology, the histopathology result was consistent with metastatic prostate cancer. He is currently being managed with hormone therapy and is clinically well with PSA levels falling to near normal levels.

The finding of asymmetric enhancement involving both the peripheral and central zones on contrast-enhanced CT is strongly suggestive of prostate carcinoma and should trigger appropriate referral and workup; in this case the widespread sclerotic lesions would make the diagnosis of prostate carcinoma almost certain.

Assessment of local involvement (e.g. seminal vesicles, bladder, vesicoureteric junction) should be included where possible in the report, in this case there is some enhancement of the right seminal vesicle which appears contiguous with the enhancing right prostatic mass suggestive of local invasion.