A Review of Prostatitis

A recent Review on prostatitis provided a comprehensive summary but presented computed tomography (CT) as the sole advanced imaging technique for suspected prostatic abscess. In our view, magnetic resonance imaging (MRI) offers distinct advantages over CT in this clinical context. Transrectal ultrasonography (TRUS) is the first-line study for diagnosis of prostatic abscess, with sensitivity approaching 80%, and provides the added benefit of enabling image-guided drainage. Its limitations include operator dependency, patient discomfort, and inability to reliably assess extraprostatic spread of infection. For patients unable to undergo TRUS, CT is widely used because it is an easily accessible and cost-effective alternative. Computed tomography effectively visualizes larger abscesses and gas-forming infections but is less sensitive for small or multiloculated abscesses. For patients who are hemodynamically unstable, CT is useful because it can be rapidly obtained and iswidely available.However, the rationale for CT use does not apply to subacute or chronic presentations of prostatitis, for which MRI can have improved diagnostic accuracy. Magnetic resonance imaging provides superior soft tissue contrast, allowing earlier and more accurate identification of abscesses, which appear T1-hypointense and T2-hyperintense with restricted diffusion and peripheral enhancement. Diffusion-weighted imaging further enhances abscess detection and characterization, with very low diffusion coefficient values reflecting pus content. Magnetic resonance imaging also is helpful in defining extraprostatic extension of infection to seminal vesicles, periprostatic tissues, or pelvic sidewalls. In addition, MRI does not use ionizing radiation, an important consideration in younger or middle-aged men who require follow-up imaging because CT radiation increases oncologic risk andmay impair spermatogenesis, potentially affecting fertility. With an external phased-array coil, high-quality images can be obtained without an endorectal probe, improving tolerability in symptomatic patients.