The left peripheral zone of the prostate shows an ill-defined ovoid mass with underlying contour bulge, yet not breaching the prostatic capsule with no obvious infiltration of the periprostatic fat, neurovascular bundles or seminal vesicles.
This lesion measures 2 x 2.5 x 3 cm in its maximal orthogonal dimensions and exhibits low signals on T2 WIs and ADC, with bright signals on DWI (b value = 1500 s/mm2), as well as avid enhancement on early dynamic post-contrast series (positive DCE) and washout on delayed post-contrast series [PIRADS 5].
Single voxel MRS reveals elevated Choline peak at 3.2 ppm with increased Choline+Creatine to Citrate ratio, highly suggestive of malignancy.