Diffuse, Bilateral Prostate Imaging Reporting and Data System (PI-RADS) 3 Changes Reported as Inflammation and Their Relation to Clinically Significant Prostate Cancer: A Retrospective Observational Study

Aim/Objective The aim of this study was to investigate if diffuse, bilateral PI-RADS (Prostate Imaging Reporting and Data System) 3 changes, reported on MRI Prostate, harbour clinically significant prostate cancer (csPCa) within them. Methods Data from 108 men with diffuse, bilateral PI-RADS 3 changes on MRI of the prostate who underwent systematic prostate biopsy between January 2000 and November 2023 were analyzed. Histology results were classified as benign or malignant, and clinically significant prostate cancer (csPCa) was defined according to the European Association of Urology (EAU) guidelines as ISUP GG (International Society for Urological Pathology Grade Group) 2 or higher. Data were analyzed using SPSS software, version 26.0 (IBM Corp., Armonk, NY, USA). Results The analysis showed that 30.5% of men with bilateral diffuse PI-RADS 3 changes had a diagnosis of clinically significant prostate cancer. There was a correlation (p-value < 0.05) of prostate-specific antigen density (PSAd) to the diagnosis of cancer in these diffuse PI-RADS 3 changes. Conclusion The likelihood of clinically significant prostate cancer in diffuse PI-RADS 3 changes is quite high, especially when associated with a high PSA density. Therefore, caution is necessary before deciding against biopsying these changes, even if they appear inflammatory on MRI.