Fig. 5

Clinical Notes: Known prostate cancer Gleason 6 under active surveillance diagnosed 1 year ago. PSA 5.4 ng/ml. Under α₁-adrenergic receptor therapy for BPH.

Technical Details: Standard prostate MRI protocol, 3 T MRI scanner, 13 ml Multihance.

Findings: Enlarged prostate of circa 48 ml (58 mm × 38 mm × 42 mm × 0.52). Peripheral zone: On high b-value DW images and ADC map normal peripheral zone with indistinct hypointensities on the ADC map (PI-RADS 2). Transition zone: On T2w image lesion of 9 mm maximal extension (white arrow) at the mid-level in the anterior half on the right with heterogeneous, indistinct triangular, signal intensity with obscured margins with mild hypointense signal (PI-RADS 3). The lesion is showing mildly hyperintense signal on high b-value DW image (white arrowhead) and moderate signal intensity on ADC map (black arrowhead) (ADC ~850 × 10⁻⁶mm²/s) (PI-RADS 3). DCE-MRI is rated positive, showing a focal enhancement, earlier than adjacent prostate tissue (black arrow). Multiple circumscribed hypointense encapsulated nodules (BPH) (PI-RADS 2). No suspicious locoregional or pelvic lymph nodes. No suspicious bone lesions. No additional findings.

Conclusion: The presence of clinically significant prostate cancer is equivocal in the transition zone showing a lesion in the right anterior mid-level corresponding to PI-RADS 3. No suspicious lymph nodes or bone lesions.

Histology: MRI-TRUS fusion guided biopsy revealed Gleason score 3 + 3 = 6