Objectives <p>To evaluate the added value of intravoxel incoherent motion (IVIM)-diffusion-weighted imaging (DWI) MRI in prostate cancer diagnosis.</p> Patients &amp; methods <p>One hundred and sixty patients were included in this study. DWI images were processed by IVIM and monoexponential model for quantitation of diffusion coefficient (<i>D</i>), pseudo-diffusion coefficient (<i>D</i>^*), perfusion fraction (<i>f</i>), and apparent diffusion coefficient (ADC). The multi-parametric data were compared between PCa and BPH group. Correlations between parameters and Gleason scores of PCa were assessed with Spearman rank test. ROC analysis was used to evaluate and compare the diagnostic ability of each parameter for discriminating PCa from BPH. Logistic regression model was used to evaluate the diagnostic performance of combination of different histogram parameters.</p> Results <p>In total, 160 patients with prostatic lesions with mean age 62.3 ± 7.93 years. The main presenting symptoms were either obstructive irritative lower urinary tract symptoms (65.6%) or hematuria (34.4%). About 55.6% of patients were considered as BPH as well as 44.4% of patients were considered as prostate adenocarcinoma. T staging system showed that 29.6% of patients were T2b, 22.5% of patients were either T3b or T4 while 14.1% of patients were T2a and 11.3% of patients were T2c. PIRADS exhibited 83.1% sensitivity and 97.75% specificity with 91.3% accuracy. Among the IVIM parameters, ADC exhibited the highest diagnostic performance with a sensitivity of 95.51%, specificity of 91.55%, and an AUC of 0.915, indicating excellent discriminatory power.</p> Conclusion <p>IVIM may have a role in prostate cancer diagnosis specially ADC in addition to PSA level and PIRADS.</p>