Histology

Multiple bilateral core biopsies. Adenocarcinoma in all cores. Highest Gleason score 3+4=7.

Comment

In early post-biopsy prostate imaging, hemorrhage can degrade image quality (with T1w hyperintensities). The matter of timing is contentious, especially if imaging will steer treatment options.

In some cases, abnormal prostate tissue will not produce normal levels of citrate, an endogenous anticoagulant, which results in areas with less blood product than expected. This "hemorrhage exclusion sign", in conjunction T2w and DWI findings can help identify tumors.