Abdominal Radiology

, Volume 42, Issue 7, pp 1956–1962 | Cite as

Clinical and multiparametric MRI signatures of granulomatous prostatitis

  • Soroush Rais-Bahrami
  • Jeffrey W. Nix
  • Baris Turkbey
  • Jason A. Pietryga
  • Rupan Sanyal
  • John V. Thomas
  • Jennifer B. Gordetsky
Article
First Online:

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.

Keywords

Granuloma Tuberculosis Prostate adenocarcinoma Magnetic resonance imaging Apparent diffusion coefficient 

Abbreviations

BCG

Bacillus Calmette–Guerin

MRI

Magnetic resonance imaging

MR/US

Magnetic resonance/ultrasound

MP-MRI

Multiparametric MRI

PCa

Prostate cancer

PSA

Prostate specific antigen

PSAD

Prostate specific antigen density

TRUS

Transrectal ultrasound

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Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

Soroush Rais-Bahrami and Jeffrey W. Nix are consultants for Philips/InVivo Corp. Baris Turkbey is an employee of the US Federal Government at the National Cancer Institute of the National Institutes of Health. Jason A. Pietrygra, Rupan Sanyal, John V. Thomas, and Jennifer B. Gordetsky have no conflict of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study as per the requirements of the Institutional Review Board approval for this study.

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Copyright information

© Springer Science+Business Media New York (outside the USA) 2017

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Department of RadiologyUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Molecular Imaging Program, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  4. 4.Department of PathologyUniversity of Alabama at BirminghamBirminghamUSA

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