Fig. 1

67-year-old man with persistently elevating PSA up to 6 μg/l. On this mpMRI a very suspicious lesion is detected in the apex of the prostate at the left side (white star). Morphologically it is demonstrated as an area of low SI with irregular margins on T2-WI (a), low ADC value (b) with high SI on the high-b-value image (c) of the DWI, strong contrast enhancement (d) with early and high peak enhancement with wash-out on the DCE curve (e). On MRSI the citrate peaks are reduced and the choline peaks elevated. The overall assessment score of this exam was PI-RADS 5. A targeted TRUS-biopsy with knowledge of the mpMRI findings (i.e., a MR-guided biopsy with cognitive fusion) confirmed a Gleason 4 + 5 PC in the apex at the left side