Finding: The lesion in the left anterior transition zone demonstrates homogeneous mildly decreased T2 signal. Its round shape and well-defined margin are characteristic of a BPH nodule. TZ lesions suggestive of stromal BPH warrant a T2 score of 2. Stromal BPH nodules will commonly show decreased ADC, increased signal on high b-value DWI, and early enhancement, thereby overlapping with potential imaging findings of TZ tumors. Although this lesion receives a DWI score of 3 given mild-to-moderate signal changes on ADC and high-b DWI, the overall category remains a 2 given the dominant role of T2WI in determining the overall category for TZ lesions.
T2WI: 2. DWI: 3. PI-RADS: 2.
MRI/TRUS fusion biopsy: Benign.