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Clinical and multiparametric MRI signatures of granulomatous prostatitis

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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.

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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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Authors and Affiliations

  1. Department of Urology, University of Alabama at Birmingham, Faculty Office Tower 1107, 510 20th Street South, Birmingham, AL, 3529, USA

    Soroush Rais-Bahrami, Jeffrey W. Nix & Jennifer B. Gordetsky

  2. Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Soroush Rais-Bahrami, Jason A. Pietryga, Rupan Sanyal & John V. Thomas

  3. Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Baris Turkbey

  4. Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA

    Jennifer B. Gordetsky

Authors
  1. Soroush Rais-Bahrami
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  2. Jeffrey W. Nix
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  3. Baris Turkbey
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  4. Jason A. Pietryga
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  5. Rupan Sanyal
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  6. John V. Thomas
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  7. Jennifer B. Gordetsky
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Corresponding author

Correspondence to Soroush Rais-Bahrami.

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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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Rais-Bahrami, S., Nix, J.W., Turkbey, B. et al. Clinical and multiparametric MRI signatures of granulomatous prostatitis. Abdom Radiol 42, 1956–1962 (2017). https://doi.org/10.1007/s00261-017-1080-0

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  • DOI: https://doi.org/10.1007/s00261-017-1080-0

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