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62-year-old patient with serum PSA level of 4.11 ng/mL. Prostate MRI shows lesion in left midanterior transition zone. Lesion (arrow) shows hypointensity on T2-weighted image (A), hyperintensity on high b-value DWI (B), hypointensity on ADC map (C), and focal early enhancement on dynamic contrast-enhanced image (D). Lesion was assessed as category 4 using PI-RADS version 2.1 MRI-targeted biopsy of lesion revealed prostate adenocarcinoma with ISUP grade group 2. At subsequent radical prostatectomy performed 6 months after biopsy, ISUP grade group was upgraded to 3. ISUP, International Society of Urogenital Pathology. Image courtesy of AJR.

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62-year-old patient with serum PSA level of 4.11 ng/mL. Prostate MRI shows lesion in left midanterior transition zone. Lesion (arrow) shows hypointensity on T2-weighted image (A), hyperintensity on high b-value DWI (B), hypointensity on ADC map (C), and focal early enhancement on dynamic contrast-enhanced image (D). Lesion was assessed as category 4 using PI-RADS version 2.1 MRI-targeted biopsy of lesion revealed prostate adenocarcinoma with ISUP grade group 2. At subsequent radical prostatectomy performed 6 months after biopsy, ISUP grade group was upgraded to 3. ISUP, International Society of Urogenital Pathology. Image courtesy of AJR.

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