Heterotopic prostatic tissue mimicking prostate cancer: the decisive role of multiparametric MRI

A man in his 70s was referred for urological evaluation because of a progressive increase in serum prostate-specific antigen levels. The patient had no significant lower urinary tract symptoms and no previous history of prostate cancer. Transabdominal ultrasound revealed a solid hypoechoic nodular lesion adjacent to the prostate in the right posterolateral periprostatic region, with inconclusive features and an indeterminate differential diagnosis. Multiparametric prostate MRI demonstrated a well-defined periprostatic nodule showing signal intensity, diffusion characteristics and contrast-enhancement patterns identical to those of the prostatic transitional zone. Based on imaging findings, heterotopic prostatic tissue was suspected. A targeted biopsy of the lesion was performed to exclude malignancy. Histopathological examination revealed benign prostatic glands with stromal components consistent with normal prostatic tissue, confirming the diagnosis of heterotopic prostatic tissue. The patient was managed conservatively, with reassurance and clinical follow-up, avoiding unnecessary aggressive treatment.