Figure 1 (A-E): A 76-year-old man with lower urinary tract symptoms, serum PSA 32.2 ng/ml. Gray scale TRUS (A), CEUS images (B), paired elastogram (colour C; gray scale D), and photomicrograph (E) (H and E) of TRUS guided biopsy; all showing an ill circumscribed nodule (star) in the PZ of mid-gland on the right corresponding to an area of abnormality on per-rectal examination. This nodule is hyperechoic (A), shows enhancement (B) and relatively hard (C, D). Hard areas are displayed as red and soft areas as green. On histopathology the nodule was diagnosed to be a cancer on histopathology. Three out of 12 cores showed features of high grade, Gleason score 10 (5+5), adenocarcinoma. Note the persistent enhancement of the central gland and another larger hard nodule (C, D; encircled) in the central gland on the left. This was a benign hyperplastic nodule on histopathology.