Clinical and multiparametric MRI signatures of granulomatous prostatitis.

Academic Article

Abstract

  • PURPOSE: The purpose of the study is to differentiate granulomatous prostatitis (GP) from high-grade prostate cancer (PCa) based on clinical findings and imaging characteristics on multiparametric MRI (MP-MRI). METHODS: Pathology from patients undergoing MRI/US fusion-guided prostate biopsies between 2014 and 2015 was reviewed. Five patients with biopsy proven GP were identified as well as 15 patients with biopsy-proven Gleason score ≥4 + 3 = 7 PCa. Patients were matched for age, serum PSA level, and prebiopsy-assigned MP-MRI cancer suspicion scores. MP-MRI studies were reviewed to identify findings that would differentiate GP from PCa in patients who had equally high suspicion scores based upon imaging characteristics. RESULTS: All five patients with GP on MR/US fusion-targeted biopsies were assigned a PIRADS 4 or 5 suspicion score. There were equally high suspicion scores on MP-MRI for both groups (p = 0.57). Re-evaluation of the MRI characteristics of the 5 GP patients and 15 matched controls who had pathologically proven Gleason score ≥4 + 3 = 7 PCa on targeted biopsy demonstrated statistically lower mean ADC values within the index targeted lesion for PCa vs. GP (p = 0.002) Qualitatively, no patients with GP on biopsy had imaging evidence of higher-staged disease, while 33% of patients in the high-risk PCa cohort demonstrated at least one high-stage feature (p = 0.003). CONCLUSION: Patients with GP routinely have MRIs with moderate to high levels of suspicion for harboring PCa. Re-evaluation of these patients' imaging demonstrated characteristics including significantly higher ADC values and absence of high-stage features, which may help differentiate areas of GP from PCa in the future.
  • Published In

    Keywords

  • Apparent diffusion coefficient, Granuloma, Magnetic resonance imaging, Prostate adenocarcinoma, Tuberculosis, Aged, Diagnosis, Differential, Humans, Image-Guided Biopsy, Magnetic Resonance Imaging, Male, Neoplasm Grading, Prospective Studies, Prostate-Specific Antigen, Prostatic Neoplasms, Prostatitis
  • Digital Object Identifier (doi)

    Pubmed Id

  • 8412644
  • Author List

  • Rais-Bahrami S; Nix JW; Turkbey B; Pietryga JA; Sanyal R; Thomas JV; Gordetsky JB
  • Start Page

  • 1956
  • End Page

  • 1962
  • Volume

  • 42
  • Issue

  • 7