 The question that was asked is a lot of the studies that are being sent to us are pyrads, oh sorry, a lot of the studies, the question is a lot of the studies that are sent to us are Gleason 6s, 3 plus 3. In other words, the major biopsy finding or number of biopsies is a 3 and the minor is a 3. So let's say we've got 12 biopsies and 5 of them are 3s and another 5 of them are 3s. So out of the 12, 10 of them are 3s. So 3 plus 3 is 6. That's exactly kind of the cutoff area where you're stuck in no man's land. The clinician is stuck in no man's land. Not only is it a Gleason 6, which is right on the edge of being aggressive or non-aggressive, but it's also a Gleason 3 and 3. So none of the biopsies are very, very aggressive and none of them are very, very benign. So you're stuck in the middle all the way around the horn and that's where MR could be the tiebreaker. There could be an antiroapical lesion that's lurking there that you never got to with your needle because it's kind of dangerous to get in that far and that low into the prostate gland and that's where MR can really save you. So that's why you see a lot of those coming to magnetic resonance imaging. So let's look at a case. It's a patient you've all seen on prior vignettes. It's a 62, 63 year old man. He goes for a routine health fair screen. He gets a PSA with a value of 40 and he's got a mass on the right side of the gland. It's a T2 weighted image and this is one of our own medical clinicians and so very near and dear to us, but it illustrates what a Pyrad's 5 is going to look like on a T2 weighted image. In the left gland or in the blue corner so to speak, in boxes parlance, we have the curvilinear high, relatively homogenous signal of the peripheral zone. Yeah, there are these little septa in it which you see normally in all adults. Yeah, you have this tiny little nodule another area of hypointensity represents some normal vascularity of the peripheral zone and that's fine. On the left side of the patient, your right, we have the anatomic capsule. Surrounding that are some bright signal intensity related areas, some higher, some lower, representing the periprostatic venous plexus. Then we have a low signal intensity interface between the central region and the peripheral region. This represents the surgical capsule. Remember we said in the region of the urethra that glands can get a little expanded, especially near the virumontanum and you can get glandular cysts or prostate utricular cysts. Yeah, we have one. Very rarely will prostate cancer ever look like that except for cyst adenocarcinoma of the prostate which will be bigger and some mucinous carcinomas of the prostate. But garden variety adenocarcinoma of the prostate looks like this. It looks like a charcoal smudge. It has no respect for the surgical capsule. It completely transgresses and erases the surgical capsule. The overwhelming majority of it butts the anatomic capsule. And remember we said you can see it as a quote unquote circumscribed mass and I said I don't mean that you see a capsule around that. I mean you can tell where the tumor ends and the rest of the central region of the gland begins right about there. And it's a pretty large tumor goes all the way from anterior to posterior. Comes right up against infiltrates right there. I'll blow it up a little bigger so you can see it infiltrates the fibromuscular stroma. So let's scroll it. We'll go high to the base of the prostate gland up near the muscular stroma and then we'll go low. So let's get out of the base and go down lower and look how quickly we run into our tumor. We're already into our tumor right here. We're still into it. We're still into it. In fact the entire peripheral zone has been replaced. This is all tumor right here. Tumor tumor tumor abutting the capsule and as we'll see later on infiltrating and transgressing the capsule we're getting lower now a very nice demarcation of tumor versus the rest of the gland with tremendous capsular abutment on our pirates T2-5 let's go down a little lower. Still more tumor. Now let's go down to the apex. Still more tumor around back and posteriorly and now we're out of it seeing some glandular tissue only. That my friends is a pirates 5 on a T2-weighted image. Let's go to our next designation shall we?