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.

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  • 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.

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