Q: Can prostatitis misunderstood as soft lesion |do we need to go for biopsy?

Question: My dad’s age is 75 |after getting severe uti PSA total was 41| after 4 weeks it came down 10.85| we did mri. It was pirads 3| can prostatitis misunderstood as soft lesion |do we need to go for biopsy?? My dad has moderate enlarged prostate but no issue in urinating. Takes several blood pressure medicine.

Answer:
Priad3 in MRI is a moderate score which means equivocal likelihood for prostate cancer.
Thus Pirad3 lesions can be seen with cancer (<5%) and benign prostatitis (>90%) as well.
UTI usually causes the PSA to temporarily elevate and can be corrected with antibiotics, in this case the PSA went down but still in the grey zone which means moderate risk of prostate cancer.
Any risk degree for prostate cancer must be checked, free PSA % and DRE are helpful tools especially if MRI imaging isn’t clear like this.

Recommendations:
Short-term follow-up imaging is advised for these patients, less than 6 months.
Do biopsy if PSA free% is lower than 25%, Positive DRE, with PIRAD3 MRI.
Treatment and management must be done with expert doctor in such cases.