MP42-19 A MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING (MPMRI) PILOT STUDY OF PROSTATIC PERI-URETHRAL FIBROSIS (PUF), A POSSIBLE ALTERNATIVE SOURCE OF LUTS

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP42)1 Apr 2020MP42-19 A MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING (MPMRI) PILOT STUDY OF PROSTATIC PERI-URETHRAL FIBROSIS (PUF), A POSSIBLE ALTERNATIVE SOURCE OF LUTS Alexander Kenigsberg*, Ryan Mauck, Alberto Diaz de Leon, Claus Roehrborn, Douglas Strand, and Daniel Costa Alexander Kenigsberg*Alexander Kenigsberg* More articles by this author , Ryan MauckRyan Mauck More articles by this author , Alberto Diaz de LeonAlberto Diaz de Leon More articles by this author , Claus RoehrbornClaus Roehrborn More articles by this author , Douglas StrandDouglas Strand More articles by this author , and Daniel CostaDaniel Costa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000891.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We recently described a new fibroblast subtype around the prostatic urethra. Examination of whole mounts from patients undergoing simple prostatectomy revealed that about 20% had PUF. Single cell RNA sequencing and immunostaining revealed that the origin of this fibrosis is the peri-urethral fibroblast, the only collagen-producing prostatic cell type. An emerging hypothesis is that PUF is involved in the pathogenesis of LUTS, particularly in men with smaller glands, but clinical tools are needed. The purpose of this study was to evaluate for the presence of PUF on mpMRI in men for whom whole mount data is not available. METHODS: Men who underwent 3T endorectal coil mpMRI between 2016-2018 for elevated PSA, MRI estimated prostate volume<60cc, and with known AUA symptom score (AUASS) were included. Patients with PIRADS >=2 lesions in the transition zone and prior bladder outlet surgery were excluded. Images were retrospectively interpreted by a radiologist dedicated to prostate MRI, who was aware of suspected prostate cancer (PCa) and blinded to other clinicopathologic findings. High resolution, fast spin-echo axial T2-weighted images part of the mpMRI were assessed for the presence of a PUF tissue (hypointense soft tissue encircling the intraprostatic urethra), its circumferential extent in degrees (0, 25, 50, 75, 100) and the maximum thickness (Figure 1). Univariate analysis and Pearson correlation were used to evaluate relationship between AUASS and PUF. RESULTS: 72 patients met inclusion criteria. PUF was identified in 20/72 (28%) with a mean circumferential extent of 47 degrees and thickness of 2.8 mm. The median AUASS was 7 (mild) and only 2/72 (2.8%) had an AUASS≥20 (severe). There was no difference in AUASS between those with PUF and without (7.8 vs 6.6, p=.48). Circumferential extent, PUF thickness, PSA, and prostate size did not correlate with AUASS. Only age correlated with AUASS (r=.3, p<.01). PCa on biopsy did not predict LUTS (p=.47). CONCLUSIONS: PUF is identified on mpMRI. The correlation of PUF and LUTS remains investigational, as this cohort largely had mild symptoms. Fibrotic processes remain a potential explanation for LUTS in men with smaller glands. Further investigation is necessary to define this relationship and identify these patients. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e611-e611 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Kenigsberg* More articles by this author Ryan Mauck More articles by this author Alberto Diaz de Leon More articles by this author Claus Roehrborn More articles by this author Douglas Strand More articles by this author Daniel Costa More articles by this author Expand All Advertisement PDF downloadLoading ...