Background prostate tissue is quantitatively abnormal on T2-weighted MRI in patients with clinically significant prostate cancer

In this study, we examined whether patients with clinically significant prostate cancer (csPCa) have abnormal T2-weighted signal in prostate tissue outside of index lesions identified on MRI—i.e., in the background prostate (BP). In two independent patient cohorts, normalized T2-weighted signal was systematically lower in the BP of subjects with csPCa compared to those without. Reduced T2-weighted BP signal indicated the presence of csPCa with accuracy comparable to lesion-based measurements. Consideration of T2-weighted signal in the whole prostate improved patient-level detection of csPCa over DWI alone, suggesting that it provides complementary diagnostic value.