Guidelines for BPH interventions are volume based. The degree to which different imaging modalities actually correlate to treated volume is not known for BPH. The present study compares the accuracy of preoperative Ultrasound, CT, MRI, and MRI Transitional Zone to BPH enucleation weight.
A retrospective review of patients who underwent enucleation for BPH and had preoperative TRUS, CT, and/or MRI was performed. Total prostate volumes were measured for CT, MRI, and TRUS; MRI transitional zone volume was also measured. The primary outcome was difference between enucleated pathology weight in grams and preoperative imaging volume. Differences between enucleation and imaging volume for each modality were calculated with one-way analysis of variance (ANOVA), with Tukey's honest significance test to determine pairwise significance (RStudio V1.2).
From Jan - Oct 2020, there were 114 preoperative imaging studies available for 95 patients. 34 (30%) of the studies were TRUS, 46 (40%) were CT, and 34 (30%) were MRI. MRI Transitional zone most accurately predicted enucleation volume on multivariate analysis (F-statistic p-value <0.001). Preoperative imaging was greater than enucleation volume by a median of 46 cc for TRUS, 51 cc for CT, 53 cc for MRI, and 14 cc for MRI transitional zone. Pairwise significance was reached for MRI transitional zone over CT (p-adj < 0.001), MRI transitional zone over MRI (p-adj <0.001) and MRI transitional zone over US (p-adj = 0.03).
Enucleation volume for BPH was most accurately predicted by transitional zone volume on MRI compared to total prostate volume on CT, TRUS, and MRI. MRI total volume was not superior to CT total volume. Focusing on MRI transitional zone volume rather than total prostate volume may more accurately stratify patients for BPH treatment. In experienced hands, median enucleation volume is within 14cc of MRI-TZ volume.
Journal of endourology. 2024 Sep 14 [Epub ahead of print]
Connor M Forbes, Christina Peterson, Nicole Miller
University of British Columbia, Urologic Sciences, Level 6, 2775 Laurel street, Vancouver, British Columbia, Canada, V5Z1M9; cmf.forbes@gmail.com., Vanderbilt University Medical Center, Urology, Nashville, Tennessee, United States; christina.peterson@vumc.org., Vanderbilt University Medical Center, Urology, A-1302 MCN, Nashville, Tennessee, United States, 37232; Nicole.miller@vumc.org.