Any thoughts on husband’s prostate MRI? On surveillance 12y

Posting copy of MRI
PI-RADS v2.1 score 5: clinically significant cancer is highly likely to be present. Lesion in the left anterolateral transition zone near the apex. Lesion saved in DynaCAD for biopsy localization purposes. 2. No lymphadenopathy. Note that MRI is relatively insensitive for low grade, low volume disease such as Gleason 3+3 or Gleason 3+4 disease. PI-RADS v2.1 Assessment Categories PIRADS 1: Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2: Low (clinically significant cancer is unlikely to be present) PIRADS 3: Intermediate (the presence of clinically significant cancer is equivocal) PIRADS 4: High (clinically significant cancer is likely to be present) PIRADS 5: Very high (clinically significant cancer is highly likely to be present) I, as the teaching physician, have personally reviewed these images and concur with this interpretation. 

EXAMINATION: MRI PELVIS W/WO CONTRAST 7/15/2026 11:19 AM DEMOGRAPHICS: 69 years, Male INDICATION: Malignant neoplasm of prostate PSA trend: Uptrending, PSA 5.7 on 7/12/2024. Pathology results: Biopsy in 2014 showing group 1 prostatic adenocarcinoma on the right side. COMPARISON: MR pelvis 3/20/2023. TECHNIQUE: Multiplanar, multisequence MRI Pelvis performed on the 3.0 Tesla magnet utilizing phased array pelvic coil. Multiparametric Prostate MR consisting of diffusion weighted images as well as DCE images. IV contrast dose and type documented in the medical record. Image analysis was performed on a DynaCAD workstation. FINDINGS: Prostate volume: 68 mL, calculated from 3-D volume contour. The following lesion(s) are at least mildly suspicious: ----------------------------------------------------------- Target #1 / ROI # 1 (representative axial T2 series, image #21) Location: Left transition zone, anterior lateral prostate within the apex. Measurements: 1.6 x 0.9 (in-plane cm); 0.9 (extent in cm). Volume 0.8 mL. Capsular involvement: No evidence of macroscopic extraprostatic extension. T2: On T2-weighted MR imaging, the lesion is seen as a focus of low signal intensity (T2 score = 5/5). DWI: The lesion demonstrates marked restricted diffusion (DWI score = 5/5). DCE: The lesion is associated with early enhancement (DCE positive). PIRADS V2.1 suspicion level: 5/5 ----------------------------------------------------------- The peripheral zone T2 signal is heterogeneous with indistinct ADC, typically reflective of sequelae of inflammation and fibrosis. The remaining transition zone T2 signal is heterogeneous with hypertrophic changes demonstrating matched areas of restricted diffusion and focally increased perfusion that are not clearly suspicious on T2-weighted imaging. Neurovascular bundle: Unremarkable. Seminal vesicles: No evidence of seminal vesicle invasion. Lymph nodes: No pathologically enlarged lymph nodes. Urinary bladder: Partially distended without focal abnormality. Anorectum and bowel: Normal anorectal wall architecture. Visualized bowel is unremarkable. Vasculature: Regional vasculature is patent and normal in caliber. Soft tissues: Small fat-containing right inguinal hernia. Bones: No suspicious marrow signal.