Prostate MRI characteristics in patients with inflammatory bowel disease
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Updated: Nov 22, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Hiroaki Takahashi1, Adam T Froemming1, David H Bruining2
1Mayo Clinic, Department of Radiology, Minnesota, USA.
Purpose:
Previous studies have indicated an increased risk of prostate carcinoma (PCa) associated with inflammatory bowel disease (IBD). Prostate MRI of IBD patients could be expected to show a mixture of inflammation as well as higher than normal rates of PCa, which could impact interpretation and MRI performance. The purpose of this study is to evaluate the characteristics of prostate MRI in patients with IBD.
Methods:
3140 patients with prostate MRI were evaluated. Coexisting IBD, PI-RADS score, and pathological results of prostate lesions (clinically significant PCa [csPCa]: Gleason score [GS] 7+, Non-csPCa: benign or GS 6) were assessed. The distribution of PI-RADS scoring and pathological result was assessed by chi-square test.
Results:
71 patients had IBD (IBD group), whereas the remaining 3069 patients did not (Non-IBD group). The proportion of abnormal MRI (PI-RADS 3, 4 or 5) was 51 % (36/71) in IBD group and 47 % (1436/3069) in Non-IBD groups (p = 0.513). Total of 1285 patients underwent biopsy or prostatectomy. The proportion of csPCa at pathology was 35 % (12/34) in IBD group and 56 % (699/1251) in non-IBD groups (p = 0.017). The positive predictive value of abnormal MRI for csPCa was significantly lower in IBD group (39 %, 19/31) compared to Non-IBD group (63 %, 657/1047) (p = 0.007).
Conclusion:
The proportion of csPCa at pathology and positive predictive value of abnormal MR for csPCa were lower in patients with IBD group compared to Non-IBD group.
Insights
Patients with inflammatory bowel disease (IBD) show lower rates of clinically significant prostate cancer (PCa) and reduced MRI accuracy for PCa detection. This finding impacts prostate MRI interpretation in IBD patients.
Area of Science:
- Radiology
- Gastroenterology
- Urology
Background:
- Previous studies suggest an increased risk of prostate carcinoma (PCa) in patients with inflammatory bowel disease (IBD).
- Prostate MRI in IBD patients may present challenges due to inflammation, potentially affecting interpretation and diagnostic performance.
- Understanding these characteristics is crucial for accurate PCa assessment in this population.
Purpose of the Study:
- To evaluate the specific characteristics of prostate MRI findings in patients diagnosed with inflammatory bowel disease (IBD).
- To compare the prevalence and pathological outcomes of prostate lesions between IBD and non-IBD patient cohorts.
- To assess the diagnostic performance of prostate MRI, specifically the positive predictive value for clinically significant PCa (csPCa), in IBD patients.
Main Methods:
- A retrospective analysis of 3140 patients who underwent prostate MRI was conducted.
- Data collected included the presence of IBD, PI-RADS scores, and pathological results (csPCa vs. non-csPCa).
- Statistical analysis, including chi-square tests, was used to compare PI-RADS distribution and pathological outcomes between groups.
Main Results:
- The proportion of abnormal prostate MRIs (PI-RADS 3-5) was similar between the IBD group (51%) and the non-IBD group (47%).
- However, the proportion of clinically significant PCa (csPCa) at pathology was significantly lower in the IBD group (35%) compared to the non-IBD group (56%).
- The positive predictive value of an abnormal MRI for csPCa was significantly lower in the IBD group (39%) versus the non-IBD group (63%).
Conclusions:
- Patients with IBD exhibit a lower prevalence of csPCa at pathology compared to patients without IBD.
- The positive predictive value of abnormal prostate MRI findings for detecting csPCa is significantly reduced in patients with IBD.
- These findings suggest that prostate MRI interpretation in IBD patients requires careful consideration due to altered PCa prevalence and diagnostic accuracy.
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