Fig. 3.

Case 2: a 74-year-old man with PSA 8.6 ng/ml and stage T1a Gleason 5(3 + 2) cancer (3–4 % cancer involved in the chips of a TUR-P in 2007) had already undergone three sets of negative extended-pattern biopsy at an outside facility. mpMR (upper figures) suggested a highly suspicious lesion in the left-anterior lateral transition zone and/or anterior horn peripheral zone, which corresponded with a hypo-echoic lesion on gray-scale TRUS (left bottom figure, with its diagrammatic representation in the middle bottom panel). MR/TRUS fusion targeted biopsy upgraded the lesion to Gleason 7 (3 + 4) cancer with 14 mm cancer core length (90 % core). Based on these findings, the patient terminated active surveillance and crossed-over to radical prostatectomy. Mp-MR multi-parametric magnetic resonance, TUR-P transurethral resection of prostate, TRUS trans-rectal ultrasound