FIGURE 2. A 60-year-old man with eight prior negative biopsies over a 10-year period.
During that time, a PSA increase from 4 to 50 ng/ml was observed. Arrows show regions of interest (a) T2-weighted axial MR image demonstrating a dominant lesion in the right anterior prostate with a focal low signal. (b) Diffusion-weighted axial MR image with an ADC value of 0.865 × 10−3m2/s in the corresponding area. (c) Dynamic contrast enhancement image of the corresponding area showing increased local perfusion. The lesion was classified as an image grade 4 on the basis of multiparametric features [22▪▪]. The radiologist outlined the lesion in T2 axial images. Open-source imaging software [25] was then used to produce a 3D model of the prostate including the target. A second 3D model was then generated on the basis of an outline of the prostate on ultrasound. (d) and (e) The two models were then dynamically fused, generating the composite virtual 3D model seen in a sagittal (d) and axial (e) views. The prostate is mapped in brown and the target identified in blue. A second, smaller target located peripherally was also identified. Systematic and targeted biopsies were obtained, generating the final 3D model demonstrating the location of all biopsy cores (light brown cylinders). Targeted biopsies in this patient revealed Gleason 3+4=7 CaP in the primary target. (f) Radical prostatectomy specimen demonstrated the presence of a 4.5-cm Gleason 3+4 cancer in the anterior prostate, confirming biopsy localization of the lesion. 2D, two-dimensional; 3D, three-dimensional; MR, magnetic resonance; PSA, prostate-specific antigen.