Prostate Cancer and Its Mimics—A Pictorial Review

SIMPLE SUMMARY: This review focuses on the potential challenges encountered in the interpretation of multiparametric prostate MRI (mpMRI). While mpMRI is accurate in the diagnosis of prostate cancer, false positive and false negative results can occur. The review discusses anatomical structures and benign conditions that may mimic prostate cancer, including prostatitis, ectopic and stromal benign prostate hyperplasia nodules, post-biopsy hemorrhage, and abscesses. The article provides suggestions on avoiding these pitfalls and emphasizes the importance of image quality in achieving accurate interpretations. Radiologists need to be aware of these pitfalls to enhance diagnostic accuracy in the increasingly prevalent use of mpMRI for prostate evaluation. ABSTRACT: Background: Multiparametric prostate MRI (mpMRI) is gaining wider recommendations for diagnosing and following up on prostate cancer. However, despite the high accuracy of mpMRI, false positive and false negative results are reported. Some of these may be related to normal anatomic structures, benign lesions that may mimic cancer, or poor-quality images that hamper interpretation. The aim of this review is to discuss common potential pitfalls in the interpretation of mpMRI. Methods: mpMRI of the prostates was performed on 3T MRI scanners (Philips Achieva or Siemens Magnetom Vida) according to European Society of Urogenital Radiology (ESUR) guidelines and technical requirements. Results: This pictorial review discusses normal anatomical structures such as the anterior fibromuscular stroma, periprostatic venous plexus, central zone, and benign conditions such as benign prostate hyperplasia (BPH), post-biopsy hemorrhage, prostatitis, and abscess that may imitate prostate cancer, as well as the appearance of prostate cancer occurring in these locations. Furthermore, suggestions on how to avoid these pitfalls are provided, and the impact of image quality is also discussed. Conclusions: In an era of accelerating prostate mpMRI and high demand for high-quality interpretation of the scans, radiologists should be aware of these potential pitfalls to improve their diagnostic accuracy.