Prostatitis

Preliminary Diagnosis: Prostatitis

I. What imaging technique is first-line for this diagnosis?

Ultrasound of the prostate gland. Transrectal offers better imaging.

II. Describe the advantages and disadvantages of this technique for diagnosis prostatitis.

Advantages

• Highly portable imaging modality.

• Does not expose patients to ionizing radiation.

• Exquisitely details the vascularity of the prostate gland.

• May help guide percutaneous biopsy.

Disadvantages

• Limited in sensitivity and specificity in detailing the prostate anatomy and surrounding soft tissues.

• Prostatitis is more of a clinical diagnosis.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

• CT imaging of the pelvis with contrast.

• MR imaging of the pelvis with contrast.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing prostatitis.

CT imaging of the pelvis with contrast

Advantages

• Highly details the surrounding soft tissues, vasculature, and osseous structures with great sensitivity and specificity.

• Better evaluates for any secondary complications, i.e., abscess and hemorrhage, than other imaging modalities.

Disadvantages

• Limited in detecting subtle inflammatory change seen in subtle prostatitis.

• Exposes patients to ionizing radiation.

• Prostatitis is more of a clinical diagnosis.

MR imaging of the pelvis with contrast

Advantages

• Offers exquisite detail of the surrounding soft tissues and is able to detail subtle edema of the prostate gland noted in prostatitis.

• Gold standard in detailing and characterizing the anatomy of the prostate gland and detecting any underlying inflammatory change.

• Highly sensitive and specific in evaluating the primary pathology and evaluating and characterizing any secondary complications.

Disadvantages

• May be subject to motion and susceptibility weighted artifact, degrading image quality.

• Less exquisite in detailing the surrounding osseous structures.

• Expensive.

• Time consuming.

• Prostatitis is more of clinical diagnosis.

VI. What are the contraindications for the alternative imaging techniques?

CT imaging of the pelvis with contrast

• May be contraindicated in pregnant patients.

MR imaging of the pelvis with contrast

• May be contraindicated in patients with non-MR compatible hardware.