Fig. 1

In November 2015, the patient of case 1 had a PSA level of 10.8 ng/ml and was referred for multiparametric prostate 3 T MRI for diagnostic purposes because the urinary biomarker-based risk score was 22% for high-grade PCa indicating the need for prostate biopsy. a An axial T2-weighted image shows a lesion on the left peripheral zone at the prostate base anterior side (red circle). b An axial diffusion-weighted image (DWI) shows an area of increased signal at the left peripheral zone. c An axial apparent diffusion coefficient (ADC) map shows a corresponding area of low ADC value (red circle). d A colorized perfusion map created from dynamic contrast-enhanced MRI (DCE-MRI) acquisition shows corresponding abnormal enhancement kinetics at the same location. All sequences identified the same region in the left anterior peripheral zone. The PI-RADS 5 outcome confirmed the biopsy indication of the urinary biomarker-based test outcome. TRUS-guided biopsies from that region confirmed high-grade Gleason 3 + 4 = 7 PCa