{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:41:31Z","timestamp":1791312091834,"version":"4.3.1"},"reference-count":46,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Second Department of Radiology, Medical University of Gda\u0144sk","award":["01-30023\/0005052\/01\/323\/323\/0\/2023"],"award-info":[{"award-number":["01-30023\/0005052\/01\/323\/323\/0\/2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/cancers15143682","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T21:21:46Z","timestamp":1689801706000},"page":"3682","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Prostate Cancer and Its Mimics\u2014A Pictorial Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4107-6821","authenticated-orcid":false,"given":"Anna","family":"\u017burowska","sequence":"first","affiliation":[{"name":"Second Department of Radiology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4904-7059","authenticated-orcid":false,"given":"Rafa\u0142","family":"P\u0119ksa","sequence":"additional","affiliation":[{"name":"Department of Pathomorphology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u0142","family":"Bie\u0144kowski","sequence":"additional","affiliation":[{"name":"Department of Pathomorphology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3710-9037","authenticated-orcid":false,"given":"Katarzyna","family":"Skrobisz","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Sowa","sequence":"additional","affiliation":[{"name":"Department of Urology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7799-685X","authenticated-orcid":false,"given":"Marcin","family":"Matuszewski","sequence":"additional","affiliation":[{"name":"Department of Urology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8462-2189","authenticated-orcid":false,"given":"Wojciech","family":"Biernat","sequence":"additional","affiliation":[{"name":"Department of Pathomorphology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7042-4381","authenticated-orcid":false,"given":"Edyta","family":"Szurowska","sequence":"additional","affiliation":[{"name":"Second Department of Radiology, Medical University of Gda\u0144sk, 80-214 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1056\/NEJMoa1801993","article-title":"MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis","volume":"378","author":"Kasivisvanathan","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S1470-2045(18)30569-2","article-title":"Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): A prospective, multicentre, paired diagnostic study","volume":"20","author":"Puech","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_4","first-page":"CD012663","article-title":"Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer","volume":"4","author":"Drost","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.eururo.2018.11.023","article-title":"Head-to-head Comparison of Transrectal Ultrasound-guided Prostate Biopsy Versus Multiparametric Prostate Resonance Imaging with Subsequent Magnetic Resonance-guided Biopsy in Biopsy-na\u00efve Men with Elevated Prostate-specific Antigen: A Large Prospective Mu","volume":"75","author":"Cornel","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1001\/jamaoncol.2020.7589","article-title":"Comparison of Multiparametric Magnetic Resonance Imaging-Targeted Biopsy with Systematic Transrectal Ultrasonography Biopsy for Biopsy-Naive Men at Risk for Prostate Cancer: A Phase 3 Randomized Clinical Trial","volume":"7","author":"Klotz","year":"2021","journal-title":"JAMA Oncol."},{"key":"ref_7","unstructured":"Mottet, N., Cornford, P., van den Bergh, R.C.N., Briers, E., Expert Patient Advocate (European Prostate Cancer Coalition\/Europa UOMO), Eberli, D., De Meerleer, G., De Santis, M., Gillessen, S., and Grummet, J. (2022, April 30). Guidelines on Prostate Cancer. EAU Guidel. EAU Guidel Edn Present EAU Annu Congr Milan 2023. Available online: http:\/\/uroweb.org\/guidelines\/compilations-of-all-guidelines\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1007\/s00261-019-01919-2","article-title":"False positives in PIRADS (V2) 3, 4, and 5 lesions: Relationship with reader experience and zonal location","volume":"44","author":"Stolk","year":"2019","journal-title":"Abdom. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.juro.2017.03.131","article-title":"Prospective Evaluation of PI-RADSTM Version 2 Using the International Society of Urological Pathology Prostate Cancer Grade Group System","volume":"198","author":"Mehralivand","year":"2017","journal-title":"J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/pros.2990020105","article-title":"The Zonal Anatomy of The prostate","volume":"2","author":"Mcneal","year":"1981","journal-title":"Prostate"},{"key":"ref_11","unstructured":"ACR (2022, April 01). PI-RADS \u00ae v2.1 PI-RADS \u00ae Prostate Imaging-Reporting and Data System 2019 Version 2.1 PI-RADS \u00ae Prostate Imaging-Reporting and Data System 2019 Version 2.1 ACKNOWLEDGEMENTS. Available online: http:\/\/www.acr.org\/-\/media\/ACR\/Files\/RADS\/Pi-RADS\/PIRADS-V2-1.pdf?la=en."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1016\/j.juro.2008.01.017","article-title":"Central Zone Carcinoma of the Prostate Gland: A Distinct Tumor Type With Poor Prognostic Features","volume":"179","author":"Cohen","year":"2008","journal-title":"J. Urol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1148\/radiol.11110663","article-title":"Normal central zone of the prostate and central zone involvement by prostate cancer: Clinical and mr imaging implications","volume":"262","author":"Vargas","year":"2012","journal-title":"Radiology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s13244-017-0578-x","article-title":"An update of pitfalls in prostate mpMRI: A practical approach through the lens of PI-RADS v. 2 guidelines","volume":"9","author":"Panebianco","year":"2018","journal-title":"Insights Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"109","DOI":"10.2214\/AJR.13.10699","article-title":"Radiologist, be aware: Ten pitfalls that confound the interpretation of multiparametric prostate MRI","volume":"202","author":"Rosenkrantz","year":"2014","journal-title":"Am. J. Roentgenol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2154","DOI":"10.1007\/s00261-019-02302-x","article-title":"Prostate MR: Pitfalls and benign lesions","volume":"45","author":"Chatterjee","year":"2020","journal-title":"Abdom. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Vilanova, J.C., Joan, C., Catal\u00e1, V., Algaba, F., and Laucirica, O. (2017). Atlas of Multiparametric Prostate MRI: With PI-RADS Approach and Anatomic-MRI-Pathological Correlation, Springer.","DOI":"10.1007\/978-3-319-61786-2"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1007\/s00330-011-2377-y","article-title":"ESUR prostate MR guidelines 2012","volume":"22","author":"Barentsz","year":"2012","journal-title":"Eur. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1093\/jjco\/hyh078","article-title":"Anatomical features of periprostatic tissue and its surroundings: A histological analysis of 79 radical retropubic prostatectomy specimens","volume":"34","author":"Kiyoshima","year":"2004","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1007\/s13244-015-0426-9","article-title":"Pitfalls in Interpreting mp-MRI of the Prostate: A Pictorial Review with Pathologic Correlation","volume":"6","author":"Panebianco","year":"2015","journal-title":"Insights Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/pros.20859","article-title":"Transition zone and anterior stromal prostate cancers: Zone of origin and intraprostatic patterns of spread at histopathology","volume":"69","author":"Potiron","year":"2009","journal-title":"Prostate"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/00004728-199103000-00014","article-title":"Identification of the periprostatic venous plexus by mr imaging","volume":"15","author":"Poon","year":"1991","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"77","DOI":"10.2214\/ajr.152.1.77","article-title":"Age-related changes of the prostate: Evaluation by MR imaging","volume":"152","author":"Allen","year":"1989","journal-title":"Am. J. Roentgenol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1148\/rg.2016150030","article-title":"Benign conditions that mimic prostate carcinoma: MR imaging features with histopathologic correlation","volume":"36","author":"Kitzing","year":"2016","journal-title":"Radiographics"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.acra.2014.01.013","article-title":"Dynamic contrast-enhanced MR imaging features of the normal central zone of the prostate","volume":"21","author":"Hansford","year":"2014","journal-title":"Acad Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0033-8389(05)70148-2","article-title":"Benign prostatic hyperplasia: Clinical overview and value of diagnostic imaging","volume":"38","author":"Grossfeld","year":"2000","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2233","DOI":"10.1007\/s00261-019-01936-1","article-title":"Revisiting quantitative multi-parametric MRI of benign prostatic hyperplasia and its differentiation from transition zone cancer","volume":"44","author":"Chatterjee","year":"2019","journal-title":"Abdom. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.2214\/AJR.12.8510","article-title":"Overview of Dynamic Contrast-Enhanced MRI in Prostate Cancer Diagnosis and Management","volume":"198","author":"Verma","year":"2012","journal-title":"Am. J. Roentgenol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s40134-021-00378-2","article-title":"Prostate Multiparametric MRI: Common Pitfalls in Primary Diagnosis and How to Avoid Them","volume":"9","author":"Eusebi","year":"2021","journal-title":"Curr. Radiol. Rep."},{"key":"ref_30","first-page":"7698","article-title":"Impact of post prostate biopsy hemorrhage on multiparametric magnetic resonance imaging","volume":"22","author":"Feng","year":"2015","journal-title":"Can. J. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.2214\/ajr.183.4.1831079","article-title":"Organ-confined prostate cancer: Effect of prior transrectal biopsy on endorectal MRI and MR spectroscopic imaging","volume":"183","author":"Qayyum","year":"2004","journal-title":"Am. J. Roentgenol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1016\/j.juro.2012.08.058","article-title":"Prostate MRI: The hemorrhage exclusion sign","volume":"188","author":"Purysko","year":"2012","journal-title":"J. Urol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1148\/radiol.12112100","article-title":"Value of the hemorrhage exclusion sign on T1-weighted prostate MR images for the detection of prostate cancer","volume":"263","author":"Barrett","year":"2012","journal-title":"Radiology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1148\/radiol.2482070157","article-title":"Prostate cancer: Relationships between postbiopsy hemorrhage and tumor detectability at MR diagnosis","volume":"248","author":"Tamada","year":"2008","journal-title":"Radiology"},{"key":"ref_35","first-page":"114","article-title":"Acute bacterial prostatitis: Diagnosis and management","volume":"93","author":"Coker","year":"2016","journal-title":"Am. Fam. Physician"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1086\/652861","article-title":"Treatment of bacterial prostatitis","volume":"50","author":"Lipsky","year":"2010","journal-title":"Clin. Infect. Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.pop.2010.04.007","article-title":"Prostatitis: Acute and Chronic","volume":"37","author":"Ramakrishnan","year":"2010","journal-title":"Prim. Care Clin. Off. Pract."},{"key":"ref_38","first-page":"290","article-title":"Common questions about chronic prostatitis","volume":"93","author":"Holt","year":"2016","journal-title":"Am. Fam. Physician"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"388","DOI":"10.4111\/icu.2019.60.5.388","article-title":"Inflammation appears as high prostate imaging\u2014Reporting and data system scores on prostate magnetic resonance imaging (MRI) leading to false positive mri fusion biopsy","volume":"60","author":"Rourke","year":"2019","journal-title":"Investig. Clin. Urol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1111\/iju.13451","article-title":"Diagnosis and treatment of patients with prostatic abscess in the post-antibiotic era","volume":"25","author":"Ackerman","year":"2018","journal-title":"Int. J. Urol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jrid.2015.04.003","article-title":"Prostatic abscess and seminal vesicle abscess: MRI findings and quantitative analysis of apparent diffusion coefficient values","volume":"2","author":"Ren","year":"2015","journal-title":"Radiol. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1038\/s41585-019-0212-4","article-title":"Multiparametric MRI for prostate cancer diagnosis: Current status and future directions","volume":"17","author":"Stabile","year":"2020","journal-title":"Nat. Rev. Urol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s13244-021-00996-6","article-title":"Understanding PI-QUAL for prostate MRI quality: A practical primer for radiologists","volume":"12","author":"Giganti","year":"2021","journal-title":"Insights Imaging"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.acra.2020.10.019","article-title":"Influence of Enema and Dietary Restrictions on Prostate MR Image Quality: A Multireader Study","volume":"29","author":"Purysko","year":"2022","journal-title":"Acad Radiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2770","DOI":"10.1007\/s00261-020-02916-6","article-title":"Do antispasmodics or rectal enemas improve image quality on multiparametric prostate MRI? An \u2018Evidence-Based Practice\u2019 review of the literature","volume":"46","author":"Brennan","year":"2021","journal-title":"Abdom. Radiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.ejrad.2017.02.029","article-title":"Evaluating the effect of rectal distension on prostate multiparametric MRI image quality","volume":"90","author":"Caglic","year":"2017","journal-title":"Eur. J. Radiol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/14\/3682\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:15:06Z","timestamp":1760127306000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/14\/3682"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,19]]},"references-count":46,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["cancers15143682"],"URL":"https:\/\/doi.org\/10.3390\/cancers15143682","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,19]]}}}