A 53-year-old patient with a PSA of 13.59, previously diagnosed with Gleason 3 + 3 cancer on 12-core template biopsy. Axial T2 weighted image shows a large hypointense signal in left midperipheral zone with capsular bulge (arrow) (a). Axial diffusion weighted imaging showing left hypointense signal in left midperipheral zone (arrow) (b). Axial high “” value DW MRI () with hyperintense signal in left midperipheral zone (arrow) (c). Axial dynamic contrast enhanced imaging showing strong early enhancement in the left midperipheral zone (arrow) (d). Magnetic resonance spectroscopic imaging showing an increased choline : citrate ratio in the left mid peripheral zone (outlined in red). Normal choline : citrate ratio is seen in the contralateral peripheral zone (outlined in blue) (e). Patient underwent a MP-MRI followed by MRI/TRUS fusion guided biopsy, at which time the patient was upgraded to a Gleason 4 + 4. Prostatectomy was then performed and whole-mount pathology confirms Gleason 4 + 4 in 30% of the left lobe (f).
