A 58-year-old patient with a PSA of 4.84, previously diagnosed with Gleason 3 + 4 cancer on 12-core template biopsy. Axial T2 weighted image showing hypointense signal in right midperipheral zone with signs of capsular irregularity and suspicion of extracapsular extension (ECE) (arrow) (a). Axial diffusion weighted image showing hypointense area in the right midperipheral zone (arrow) (b). Axial high “” value DWI () hyperintense in the right midperipheral zone (arrow) (c). Axial dynamic contrast enhanced image showing strong early enhancement in right midperipheral zone (arrow) (d). Patient underwent an MP-MRI followed by a MRI/transrectal ultrasound (TRUS) fusion guided biopsy upgrading to a Gleason 4 + 3 in all three MP-MRI determined targets of the right midperipheral zone.