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Early-detection demo · Prostate cancer

PI-RADS 4 lesion in a BRCA2 carrier flagged on mpMRI surveillance

PI-RADS 4 lesion in the right peripheral zone (1 mL) — significant DWI restriction with focal early enhancement.

Patient: Marcus · 58 · BRCA2 carrierModality: mpMRIRisk: high · 76/100
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01

Risk profile

What OCTON knew before the scan
Risk
76
high
Tier
high
African-American · BRCA2 c.6275delT · paternal uncle with metastatic prostate cancer at 62 · PSA 4.2 ng/mL.
Contributing factors
  • BRCA2 pathogenic variant+30
  • Family history (first-degree)+16
  • African-American ancestry+12
  • PSA 4.2 (rising trend)+12
  • Age 58+6
Narrative

Marcus's BRCA2 status + ancestry + rising PSA puts him in the high-risk band. NCCN Prostate v4.2025 recommends mpMRI before biopsy to maximize csPCa detection.

02

Scan + AI report

What mpMRI found · Multiparametric prostate MRI (T2 + DWI b1500 + ADC + DCE)
mpMRI · DEMO
PI-RADS 4
OCTON · scanning · live
conf 0.85
OCTON Impression · 83% confidence

Focal lesion in the right peripheral zone (mid-gland posterior) measuring 11 mm. Marked DWI restriction + low ADC (~0.62 ×10⁻³ mm²/s) + focal early enhancement on DCE — features of clinically significant prostate cancer.

Findings
  • 11 mm focal lesion · right peripheral zone mid-gland posterior · Right PZ11 mm
  • No definite extracapsular extension; intact prostatic capsule · Right PZ
  • Seminal vesicles bilaterally normal · SV
Differential diagnosis
  • Clinically significant prostate adenocarcinoma (Gleason ≥ 3+4)70%
  • Atrophic / inflammatory mimic18%
  • Granulomatous prostatitis8%
  • Indolent low-grade tumor (Gleason 6)4%
Recommended actions
  • ▸MRI-fusion targeted + systematic 12-core biopsy within 14 days
  • ▸Multidisciplinary prostate clinic referral
  • ▸Continue BRCA2 cascade-testing for first-degree relatives
Caveats
  • PI-RADS is a likelihood score; histopathology required for diagnosis.
  • BRCA2-driven tumors are more aggressive — favor radical treatment if confirmed.
03

360° Preventative plan

Drugs · surveillance · diet · exercise · lifestyle — generated for this case
Clinical anchors
Drugs · labs · imaging · surveillance
Medical
PSA + free-PSA
FrequencyEvery 6 months
Startsage 40
NCCN Prostate Early Detection v3.2025
Monitoring
Multiparametric prostate MRI
FrequencyAnnual
Startsage 40
NCCN Prostate Early Detection v3.2025 · BRCA2 Category 1
Monitoring
MRI-fusion biopsy on PI-RADS ≥ 3
FrequencyAs indicated
Startsage 40
AUA Localized Prostate Cancer 2024
04

What changed

The early-detection win

Annual mpMRI surveillance — driven by BRCA2 status — caught a PI-RADS 4 lesion at 11 mm before it became clinically symptomatic.

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