Related Experiment Video
Updated: Mar 20, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Differentiation of prostatitis and prostate cancer using the Prostate Imaging-Reporting and Data System (PI-RADS)
Michael Meier-Schroers1, Guido Kukuk1, Karsten Wolter1
1Department of Radiology, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.
Purpose:
To determine if prostate cancer (PCa) and prostatitis can be differentiated by using PI-RADS.
Materials And Methods:
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.
Results:
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).
Conclusion:
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.
Insights
Prostate cancer (PCa) can be differentiated from prostatitis using PI-RADS scoring on MRI. However, PI-RADS has limited use for primary prostatitis assessment, with restricted diffusion being a key indicator.
Area of Science:
- Radiology and Imaging
- Oncology
- Urology
Background:
- Prostate cancer (PCa) and prostatitis share imaging characteristics, complicating differentiation.
- Accurate diagnosis is crucial for appropriate patient management.
Purpose of the Study:
- To evaluate the efficacy of the Prostate Imaging Reporting and Data System (PI-RADS) in differentiating between PCa and prostatitis.
- To identify specific imaging parameters that aid in distinguishing these conditions.
Main Methods:
- Analysis of 3T MRI scans from 68 patients with 85 suspicious lesions, correlated with histopathology.
- Utilized T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), dynamic contrast enhancement (DCE), and MR-Spectroscopy (MRS).
- Assigned PI-RADS scores (single parameter, sum, and v2) and evaluated T2 morphology, ADC values, perfusion, and localization.
Main Results:
- PCa was present in 51.8% of lesions, prostatitis in 24.7%, and other benign tissue in 23.5%.
- PI-RADS scores (T2WI, DWI, DCE, sum, v2) were significantly higher for PCa than for prostatitis or benign tissue (p<0.001).
- Restricted diffusion (ADC≥900mm(2)/s) was observed in 100% of prostatitis cases and showed the highest predictive value (AUC=0.859). MRS and sum scores including MRS were higher for prostatitis than other benign tissue.
Conclusions:
- PI-RADS effectively differentiates PCa from prostatitis, with higher scores for cancer.
- Significant overlap exists between prostatitis and other benign findings, limiting PI-RADS for primary prostatitis assessment.
- Restricted diffusion (ADC≥900mm(2)/s) is a strong indicator for prostatitis, and MRS can aid in distinguishing prostatitis from other benign conditions.
