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Prostate Minimally Invasive Procedures: Complications and Normal vs. Abnormal Findings on Multiparametric Magnetic Resonance Imaging (mpMRI) - Beyond the Abstract

Multiparametric MRI of the prostate (mpMRI) has emerged as a key diagnostic tool in the evaluation of prostate disease, especially prostate cancer. There are more than 174,000 new cases of prostate cancer every year in the United States and the prevalence of benign prostatic hyperplasia (BPH) reaches 80% by the 9th decade of life.1,2 Many patients have concomitant disease and may undergo medical or surgical management.3,4 Due to the relative novelty of mpMRI, this study continues to be interpreted by subspecialty uroradiologists. Many urologists and general radiologists lack formal training in mpMRI.

There has been a proliferation of treatment options for BPH. While transurethral resection of the prostate (TURP) remains the gold standard to treat BPH, minimally invasive surgical therapies (MIST) have grown in popularity among patients who desire lower morbidity or are poor operative candidates.5 Available therapies include surgical options such as transurethral vaporization, prostatic urethral lift, water vapor ablation, and non-operative therapies such as prostate artery embolization. The postoperative appearance of mpMRI of these interventions is not yet well discussed in the literature; however, patients obtaining mpMRI often have undergone one of these interventions or may be receiving medical management of BPH.

Similarly, novel minimally invasive therapies for prostate cancer have been introduced as adjuncts to prostatectomy, serving as the bridge between prostatectomy and active surveillance. Available minimally invasive procedures for prostate cancer include high-intensity focused ultrasound (HIFU), cryotherapy, irreversible electroporation (IRE), focal laser ablation (FLA), and photodynamic therapy (PDT). As diagnostic techniques advance to better stratify high-risk and low-risk prostate cancer, more patients will undergo one of these bridging therapies. Just as in BPH, there is limited experience with post-operative changes on mpMRI following novel minimally invasive therapies.

With the growing number of minimally invasive therapies for both prostate cancer and BPH, it is important for the urologist and radiologist to be well versed in recognizing the appearance of common and uncommon post-procedural changes on mpMRI. These procedures can greatly alter the appearance of the prostate gland, risking misinterpretation and misdiagnosis. It is vital to have a strong understanding of MRI findings in order to recognize the difference between artifact and recurrence.6 This manuscript provides a pictorial review of mpMRI findings after multiple minimally invasive therapies for BPH and prostate cancer.

Written by: Anvesh R. Macherla, BS,1 Roozbeh Houshyar, MD,1 Alexandar Ushinsky, MD2

  1. University of California, Irvine School of Medicine
  2. Washington University, St. Louis, Missouri

References:

  1. Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69 (1):7-34. https://doi.org/10.3322/caac.21551
  2. Hugosson J, Carlsson S (2014) Overdetection in screening for prostate cancer. Curr Opin Urol 24 (3):256-263. https://doi.org/10.1097/MOU.0000000000000054
  3. Nickel JC (2006) BPH: costs and treatment outcomes. American Journal of Managed Care 12: S141–148.
  4. Barqawi, A. B., Krughoff, K. J., & Eid, K. (2012). Current Challenges in Prostate Cancer Management and the Rationale behind Targeted Focal Therapy. Advances in Urology, 2012, 1–7. https://doi.org/10.1155/2012/862639
  5. LaBossiere JR, Wallis CJD, Herschorn S, et al. Surgical management of benign prostatic obstruction: 20-year population-level trends. Can Urol Assoc J. 2020;14:252–7. doi: 10.5489/cuaj.6224.
  6. Bardis MD, Houshyar R, Chang PD, Ushinsky A, Glavis-Bloom J, Chahine C, Bui TL, Rupasinghe M, Filippi CG, Chow DS (2020) Applications of artificial intelligence to prostate multiparametric MRI (mpMRI): Current and emerging trends. Cancers (Basel) 12(5):1204. https://doi.org/10.3390/cancers12051204


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