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(b)
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Figure 1: Multiparametric magnetic resonance imaging (mpMRI) detects significant prostate cancer. This 58-year-old man had a doubling of serum PSA in less than 2 years. For image-fusion targeted biopsy planning, mpMRI was performed. An oval, uniformly low signal mass (thick arrow) on T2-weighted imaging (T2WI) with circumscribed margins (a) is associated with focal high signal on diffusion-weighted imaging (DWI) (b) and low signal on the apparent diffusion coefficient (ADC) map (c) signifying restricted diffusion and focal asymmetric enhancement with washout (d) on dynamic contrast-enhanced (DCE) perfusion imaging. Targeted biopsies of this area revealed high volume Gleason 4 + 3 = 7 cancer. Standard systematic or “blind” sextant biopsies, which normally preferentially target the posterior gland, were all negative for any cancer.