From the Guidelines
MRI plays a valuable but selective role in the diagnosis and management of Benign Prostatic Hyperplasia (BPH), particularly in complex cases where standard evaluation with ultrasound and other clinical assessments provides insufficient information. While not routinely used as a first-line diagnostic tool for BPH, multiparametric MRI provides detailed anatomical information about prostate size, shape, and tissue characteristics that can guide treatment decisions.
Key Points:
- MRI is helpful in distinguishing BPH from prostate cancer when PSA levels are elevated or digital rectal examination findings are concerning 1.
- It can accurately measure prostate volume, which is important for determining appropriate treatment options such as medication selection (alpha-blockers like tamsulosin or 5-alpha reductase inhibitors like finasteride) or surgical approaches.
- MRI helps visualize the precise location of prostatic enlargement, identifying whether it primarily affects the central zone, transition zone, or peripheral zone, which influences surgical planning.
- For patients considering minimally invasive treatments like prostate artery embolization or prostatic urethral lift, MRI provides crucial anatomical details.
- The technology works by using strong magnetic fields and radio waves to generate detailed cross-sectional images without radiation exposure, making it safe for repeated use in monitoring disease progression.
- However, due to cost considerations and availability limitations, MRI is typically reserved for cases where standard evaluation with ultrasound and other clinical assessments provides insufficient information 1.
Recommendations:
- Clinicians should consider assessment of prostate size and shape via abdominal or transrectal ultrasound, or cystoscopy, or by preexisting cross-sectional imaging (i.e. magnetic resonance imaging/computed tomography) prior to surgical intervention for LUTS/BPH 1.
- Clinicians should perform a post-void residual assessment prior to surgical intervention for LUTS/BPH 1.
- Clinicians should consider uroflowmetry prior to surgical intervention for LUTS/BPH 1.
From the Research
Role of MRI in BPH Diagnosis and Management
- MRI plays a significant role in the assessment and treatment of Benign Prostatic Hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) 2.
- Prostate MRI provides exceptional anatomic detail, allowing for the classification of BPH and detailed assessment of response to various treatment modalities 2.
- MRI can be used to evaluate the efficacy of different BPH treatments, including simple prostatectomy, transurethral resection of the prostate, UroLift, and prostatic artery embolization 2, 3.
Pre- and Post-Therapeutic Considerations
- Pre- and post-procedural MRI is not routinely performed for LUTS due to BPH treatments, but it is essential for accurate interpretation of prostate MRI performed after treatment 4.
- Different BPH treatments result in distinct changes on MRI, such as:
- Reduction in prostate volume, particularly in the periurethral prostatic tissue 4, 3.
- Creation of areas of necrosis and distortion of normal zonal anatomy after ablations 4.
- Infarcts in the transition zone after prostate artery embolization 4.
- Susceptibility artifacts that can obscure lesion detection in the transition zone after mechanical prostatic urethral lift devices 4.