Indeterminate Prostate Lesion
An indeterminate prostate lesion is an abnormal area seen on imaging that cannot be clearly classified as benign, inflammatory, or malignant based on its current appearance. These lesions may represent benign enlargement, inflammation (prostatitis), scarring, a benign cyst, or early prostate cancer. Because many prostate findings overlap in appearance, additional imaging or follow-up is often needed.
What is it?
An indeterminate prostate lesion is a prostate finding that does not have enough specific characteristics on imaging to determine whether it is benign or malignant. On MRI, these lesions may appear as areas of altered signal, subtle nodules, or regions with minimal diffusion restriction. They may represent benign processes such as BPH nodules, inflammation, or cysts—but early prostate cancer can look similar.
Multiparametric MRI provides detailed information by evaluating tissue structure, blood flow, and cellular density. When imaging features remain ambiguous, follow-up MRI or targeted biopsy may be recommended, especially if PSA levels are elevated or rising.
Important to Know
Most indeterminate prostate lesions are ultimately benign, especially in younger individuals or those with stable PSA levels. Radiologists use standardized scoring systems such as PI-RADS to communicate how concerning a lesion appears. Low-score lesions may simply need follow-up, while higher-score lesions may require biopsy.
Red flag symptoms include difficulty urinating, blood in the urine or semen, persistent pelvic pain, or a rapidly rising PSA level. These signs may indicate inflammation, obstruction, or a more concerning lesion requiring prompt evaluation. Follow-up imaging helps monitor stability or detect important changes.