Influence of benign prostatic hyperplasia patterns detected with MRI on the clinical outcome after prostatic artery embolization

Abstract Background To investigate the influence of MRI hyperplasia patterns in benign prostate hyperplasia (BPH) and tissue composition on outcome parameters in a collective of patients undergoing prostate artery embolization (PAE). Materials & Methods This retrospective study included patients (median age 72y) with the diagnosis of BPH, who underwent magnetic resonance imaging (MRI) of the prostate followed by PAE at a single centre. MRI scans were evaluated and BPH patterns were determined according to Wasserman type and a modified BPH classification. Additionally, scans were evaluated regarding the presence of adenomatous-dominant benign prostatic hyperplasia (AdBPH). Lower urinary tract symptoms (LUTS) were assessed using the International Prostate Symptom Score (IPSS) and urinary flow rate (Qmax). Follow-up examination included MRI and clinical outcome. Results For clinical outcome at follow-up, IPSS showed median reduction of 54% (IQR 41 - 75%) and Qmax improved by 4.1 ml/s. We noted significant reduction in volume, intraprostatic protrusion and prostatic urethra angle in our collective (p < 0.01). Median volume reduction was 25% (IQR 15% - 34%). Multiple linear regression model showed significant effect of high initial volume on reduction in IPSS scores after treatment (p < 0.01). Presence of AdBPH was significantly associated with both volume loss and clinical improvement in terms of IPSS reduction (p < 0.01). Neither BPH patterns based on the Wassermann type nor modified BPH classifications were significantly related with postinterventional IPSS and volume loss. Conclusions Men benefit from PAE regardless the macroscopic BPH MRI pattern. Preinterventional prostate volume, presence of AdBPH on MRI, and IPSS should be considered for outcome prognosis after prostatic artery embolization.