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Preablation, postablation, and recurrence multiparametric MRI scans depict a 63-year-old man treated with transperineal focal laser ablation (TPLA) for localized prostate cancer. Clinical parameters included an initial prostate-specific antigen (PSA) level of 7.2 ng/mL, a Prostate Imaging Reporting and Data System (PI-RADS) grade 4 lesion (red circles) in the right apical peripheral zone, and a maximum tumor length of 5 mm. MRI-guided targeted biopsy confirmed a Gleason score 3+4 prostate cancer tumor. (A) Pre-ablation axial T2-weighted MRI scan and apparent diffusion coefficient (ADC) image shows the apical PI-RADS 4 lesion (circles). (B) Six-month post-ablation axial T2-weighted MRI scan and ADC image show cystic necrosis (arrows). There was no evidence of recurrence; the PSA level was 1.5 ng/mL. (C) One-year after ablation, the patient’s PSA level had increased to 4.3 ng/mL. Axial T2-weighted MRI scan and the ADC image shows a recurrent lesion (blue circles) in the right apical peripheral zone adjacent to the ablation scar. Targeted biopsy confirmed Gleason score 3+4 prostate cancer, which was classified as in-field recurrence of clinically significant prostate cancer and subsequently re-treated with TPLA. In summary, serial multiplanar MRI demonstrates treatment response after TPLA with post-ablation necrosis, followed by MRI-detected IFR confirmed with biopsy at 12-month follow-up. Multiparametric MRI was performed with a 3.0-T MRI scanner (Skyra; Siemens Healthineers) using T2-weighted, diffusion-weighted, and ADC sequences, with gadobenate dimeglumine contrast material administration (Bracco Diagnostics).
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