Diagnosis of prostate cancer depends on elevated serum PSA level and DER and confirmed with trans-rectal US–guided biopsy using sextant samples obtained from the peripheral zone .

Multiple limitation factors for PSA include:

1. Low specificity of serum PSA for the detection of cancer
prostate and may leads to unnecessary biopsy.
2. Many prostatic condition (eg, benign prostatic hyperplasia, acute or chronic prostatitis) elevate serum PSA value.

Functional MR imaging techniques combined with conventional imaging had provided improved cancer detection and localization, as well as information regarding the aggressiveness and volume of cancers for individualized therapy. Our study proved that MP-MRI had (100%) sensitivity,(96.6%) specificity, (95.8%)positive predictive value and (100%) negative predictive values compared to the use of T2WI only which had 95.6% sensitivity, specificity 70%, (71%) positive predictive value and (95.5%) negative predictive value.

In our study also we concluded that the cutoff point of ADC value for areas with positive biopsy findings was less than ( 0.85 mm2/sec2) with positive correlation with Gleason score in which the mean ADC values for low grade tumor was 0.7+0.4 mm2/sec, intermediate grade was 0.5+0.14 and for high grade is 0.33+0.12.

The cutoff point of H-MRS of (CH+CR/CIT) was more than 1.82 in areas with positive biopsy with positive correlation with Gleason score in which the mean ratio for low grade is (3.08+1.47), intermediate grade is (4.98+1.32) and for high grade is (7.56+2.12) with no significant statistical differences to biopsy results p-value 0.001.

The results of our study showed that both diffusion-weighted image and H-MRS should be considered as additional and complementary tools to the conventional T2WI due to their high sensitivity and specificity not only for detecting prostate cancer, but also for prostate cancer grading in correlation with Gleason score.