The British journal of radiology · 2026
PI-RADS 3-5 lesions MRI pattern after prostate artery embolization.
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Bossi Croci Romain, Sapoval Marc, Dariane Charles, Pellerin Olivier, Thiounn Nicolas, Dean Carole, Boeken Tom, Bodard Sylvain
Аннотация
OBJECTIVES: To evaluate changes in Prostate Imaging Reporting and Data System (PI-RADS) ≥3 lesions on prostate MRI after prostate artery embolization (PAE) performed for lower urinary tract symptoms.
METHODS: This retrospective single-center study included 18 consecutive patients, each presenting with 1 PI-RADS ≥3 prostatic images on pre-PAE MRI and who underwent follow-up MRI after PAE. We assessed changes in PI-RADS score, infarcted areas, and prostate volume.
RESULTS: Before PAE, all 18 lesions (mean PSA density: 0.078) were either biopsy-negative (n = 4) or deemed not requiring biopsy based on multidisciplinary consensus (n = 12), except for 1 case of non-clinically significant prostate cancer identified before PAE and 1 patient with a PIRADS 4 lesion who declined biopsy. The mean delay to post-PAE MRI was 120 days. After PAE, no new PI-RADS ≥3 lesions appeared, and no lesion was upgraded. Both initially classified as PI-RADS 5 lesions (negative on biopsies) were downgraded to PI-RADS 1. Among the 6 PI-RADS 4 lesions, 3 remained stable, 2 were downgraded to PI-RADS 3, and 1 to PI-RADS 2. Of the 10 PI-RADS 3 lesions, 8 achieved PI-RADS 1 status, and 2 remained stable.
CONCLUSIONS: Following PAE, pre-existing PI-RADS ≥3 lesions demonstrate stability or reduction in PI-RADS on MRI. However, radiopathological correlation studies are warranted to estimate the diagnostic reliability of the PI-RADS score in the post-PAE settings.
ADVANCES IN KNOWLEDGE: This study shows that PI-RADS ≥3 images are downgraded after PAE. It does not imply that potential prostate cancer can be cured by PAE.
METHODS: This retrospective single-center study included 18 consecutive patients, each presenting with 1 PI-RADS ≥3 prostatic images on pre-PAE MRI and who underwent follow-up MRI after PAE. We assessed changes in PI-RADS score, infarcted areas, and prostate volume.
RESULTS: Before PAE, all 18 lesions (mean PSA density: 0.078) were either biopsy-negative (n = 4) or deemed not requiring biopsy based on multidisciplinary consensus (n = 12), except for 1 case of non-clinically significant prostate cancer identified before PAE and 1 patient with a PIRADS 4 lesion who declined biopsy. The mean delay to post-PAE MRI was 120 days. After PAE, no new PI-RADS ≥3 lesions appeared, and no lesion was upgraded. Both initially classified as PI-RADS 5 lesions (negative on biopsies) were downgraded to PI-RADS 1. Among the 6 PI-RADS 4 lesions, 3 remained stable, 2 were downgraded to PI-RADS 3, and 1 to PI-RADS 2. Of the 10 PI-RADS 3 lesions, 8 achieved PI-RADS 1 status, and 2 remained stable.
CONCLUSIONS: Following PAE, pre-existing PI-RADS ≥3 lesions demonstrate stability or reduction in PI-RADS on MRI. However, radiopathological correlation studies are warranted to estimate the diagnostic reliability of the PI-RADS score in the post-PAE settings.
ADVANCES IN KNOWLEDGE: This study shows that PI-RADS ≥3 images are downgraded after PAE. It does not imply that potential prostate cancer can be cured by PAE.