Incidental Large Exophytic Prostatic Cyst in an Asymptomatic Male: Diagnostic Evaluation and Management

Aasim Ajaz Salati¹, Sajad Ahmad Salati²

Keywords: Prostatic cyst, multiparametric magnetic resonance imaging, proton magneticresonance spectroscopy, citrates, PIRADS

DOI: 10.63475/yjm.v5i1.0377

DOI URL: https://doi.org/10.63475/yjm.v5i1.0377

Publish Date: 30-04-2026

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Pages: 220 - 223

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Downloads: 9

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Author Affiliation:

1 Postgraduate Year 1, Department of Pharmacology, Government Medical College, Jammu, India
2 Professor, Department of Surgery, College of Medicine, Qassim University, Saudi Arabia

Abstract

Prostatic cysts are generally small, intraprostatic, and incidental. Large, multiloculated, exophytic cysts are rare and can mimic pelvic neoplasms. We report an incidental discovery of a large exophytic prostatic cyst in an asymptomatic 57-year-old male. Multiparametric magnetic resonance imaging (mpMRI) demonstrated T1 and T2 hyperintensity, suggesting proteinaceous or hemorrhagic content. Magnetic resonance spectroscopy (MRS) provided essential metabolic context, revealing a preserved citrate peak and a high citrate-to-choline ratio, which supported a benign impression. This was further corroborated by a low prostate-specific antigen (PSA) density (0.068 ng/mL/cc). Transrectal ultrasound–guided aspiration yielded 20 mL of hazy brownish fluid; cytopathology confirmed the absence of malignancy. This case emphasizes the diagnostic value of combining mpMRI, MRS, and PSA density to characterize large, complex prostatic “incidentalomas” non-invasively. Such a multi-modal approach facilitates conservativemanagement, sparing asymptomatic patients from unnecessary surgical intervention even in the

event of subsequent cyst reaccumulation.

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