BACKGROUND: Since Gleason score (GS) 4 + 3 prostate cancer (PCa) has a worse prognosis than GS 3 + 4 PCa, differentiating these two types of PCa is of clinical significance. OBJECTIVE: To assess the predictive roles of using T2WI and ADC-derived image texture parameters in differentiating GS 3 + 4 from GS 4 + 3 PCa. METHODS: Forty-eight PCa patients of GS 3 + 4 and 37 patients of GS 4 + 3 are retrieved and randomly divided into training (60%) and testing (40%) sets. Axial image showing the maximum tumor size is selected in the T2WI and ADC maps for further image texture feature analysis. Three hundred texture features are computed from each region of interest (ROI) using MaZda software. Feature reduction is implemented to obtain 30 optimal features, which are then used to generate the most discriminative features (MDF). Receiver operating characteristic (ROC) curve analysis is performed on MDF values in the training sets to achieve cutoff values for determining the correct rates of discrimination between two Gleason patterns in the testing sets. RESULTS: ROC analysis on T2WI and ADC-derived MDF values in the training set (n = 51) results in a mean area under the curve (AUC) of 0.953 +/- 0.025 (with sensitivity 0.9274 +/- 0.0615 and specificity 0.897 +/- 0.069), and 0.985 +/- 0.013 (with sensitivity 0.9636 +/- 0.0446 and specificity 0.9726 +/- 0.0258), respectively. Using the corresponding MDF cutoffs, 95.3% (ranges from 76.5% to 100%) and 94.1% (ranged from 76.5% to 100%) of test cases (n = 34) are correctly discriminated using T2WI and ADC-derived MDF values, respectively. CONCLUSIONS: The study demonstrates that using T2WI and ADC-derived image texture parameters has a potential predictive role in differentiating GS 3 + 4 and GS 4 + 3 PCa.