Differentiation of prostatitis and prostate cancer using the Prostate Imaging-Reporting and Data System (PI-RADS).

To determine if prostate cancer (PCa) and prostatitis can be differentiated by using PI-RADS.

3T MR images of 68 patients with 85 cancer suspicious lesions were analyzed. The findings were correlated with histopathology. T2w imaging (T2WI), diffusion weighted imaging (DWI), dynamic contrast enhancement (DCE), and MR-Spectroscopy (MRS) were acquired. Every lesion was given a single PI-RADS score for each parameter, as well as a sum score and a PI-RADS v2 score. Furthermore, T2-morphology, ADC-value, perfusion type, citrate/choline-level, and localization were evaluated.

44 of 85 lesions showed PCa (51.8%), 21 chronic prostatitis (24.7%), and 20 other benign tissue such as hyperplasia or fibromuscular tissue (23.5%). The single PI-RADS score for T2WI, DWI, DCE, as well as the aggregated score including and not including MRS, and the PI-RADS v2-score were all significantly higher for PCa than for prostatitis or other tissue (p<0.001). The single PI-RADS score for MRS and the PI-RADS sum score including MRS were significantly higher for prostatitis than for other tissue (p=0.029 and p=0.020), whereas the other parameters were not different. Prostatitis usually presented borderline pathological PI-RADS scores, showed restricted diffusion with ADC≥900mm(2)/s in 100% of cases, was more often indistinctly hypointense on T2WI (66.7%), and localized in the transitional zone (57.1%). An ADC≥900mm(2)/s achieved the highest predictive value for prostatitis (AUC=0.859).

Prostatitis can be differentiated from PCa using PI-RADS, since all available parameters are more distinct in cases of cancer. However, there is significant overlap between prostatitis and other benign findings, thus PI-RADS is only suitable to a limited extent for the primary assessment of prostatitis. Restricted diffusion with ADC≥900mm(2)/s is believed to be a good indicator for prostatitis. MRS can help to distinguish between prostatitis and other tissue.

European journal of radiology. 2016 Apr 29 [Epub]

Michael Meier-Schroers, Guido Kukuk, Karsten Wolter, Georges Decker, Stefan Fischer, Christian Marx, Frank Traeber, Alois Martin Sprinkart, Wolfgang Block, Hans Heinz Schild, Winfried Willinek

Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: ., Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: ., Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: ., Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: ., Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: ., Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: ., Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: ., Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: ., Department of Radiology, University of Bonn, Sigmund-Freud-Str 25, 53127 Bonn, Germany., Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Electronic address: ., Department of Radiology, Neuroradiology, Sonography and Nuclear Medicine, Hospital of the Barmherzige Brüder Trier, Nordallee 1, 54292 Trier, Germany. Electronic address: .