5-alpha reductase inhibitors (5-ARIs) are widely prescribed for the management of benign prostatic hyperplasia and are known to induce morphological and metabolic changes in prostatic tissue. This narrative review summarizes current evidence on the impact of 5-ARI therapy on multiparametric magnetic resonance imaging (mpMRI) findings and the potential clinical implications. While some studies report reduced discrimination on T2-weighted and apparent diffusion coefficient (ADC) metrics after long-term exposure, others suggest improved lesion visibility due to a more homogeneous benign background. Most studies found no significant difference in the Prostate Imaging Reporting and Data System (PI-RADS) lesion distribution between 5-ARI users and non-users. However, conflicting evidence exists regarding mpMRI sensitivity and specificity in 5-ARI-treated patients. Limited data is available on the effect of 5-ARIs on local staging accuracy. Overall, the effect of 5-ARIs on prostate mpMRI interpretation appears complex, highlighting the need for prospective studies and treatment-adjusted risk assessment tools to support clinical decision-making.
Tumminello et al. (Thu,) studied this question.