Role of Diffusion Weighted Images and Three Dimentional Magnetic Resonance Spectroscopy in Differentiation of Prostatic Cancer from Benign Prostatic Hyperplasia in Patients with Elevated Prostatic Specific Antigen

Aim of the Study: To evaluate the diagnostic and prognostic potentials of combined MRS DWI in patients with elevated protatic specific antegin (PSA). Patients and Methods: Thirty two male patients with elevated PSA and trans-rectal US guided biopsy from the prostate were included. MM study was performed using endorectal coil combined with DWI MRS studies. ADC cho+cr/citrate metabolic ratio (MET) values for each lesion were recorded along with Gleason score. Results: Out of 30 cases, 24 had prostate cancer (PC) and the remaining 6 had benign prostatic hyperplasia (BPH). Significant difference was detected between (PC) (BHP) as regards ADC MET values. We found significant negative correlation between ADC values and Gleason score, also there was significant difference in ADC values obtained for lesions with high Gleason score and those obtained from lesions with low Gleason score. No correlation was found between MET and Gleason score yet there was significant difference between MET values of lesions with high and mid Gleason score. Conclusion: In patients with elevated or borderline PSA; combined use of DWI MRS with endorectal MRI is helpful in differentiation between PC BPH. This would help to define the biopsy site and eliminate the need for more uncomfortable or painful biopsies. Furthermore, DWI is negatively correlated with Gleason score which gives idea about tumor grade.