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Updated: Mar 17, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
PI-RADS 3-5 lesions MRI pattern after prostate artery embolization
Romain Bossi Croci1, Marc Sapoval1, Charles Dariane2
1Department of Vascular and Oncological Interventional Radiology, University of Paris Cité, PARCC-INSERM Unité-970, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris F-75015, France.
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.
Insights
Prostate artery embolization (PAE) can lead to stability or downgrading of PI-RADS ≥ 3 lesions on MRI. Further studies are needed to confirm the diagnostic reliability of PI-RADS scoring post-PAE.
Area of Science:
- Radiology
- Interventional Radiology
- Urology
Background:
- Prostate artery embolization (PAE) is a treatment for lower urinary tract symptoms.
- Prostate Magnetic Resonance Imaging (MRI) with PI-RADS scoring is used to assess suspicious lesions.
- Changes in PI-RADS scores after PAE require evaluation.
Purpose of the Study:
- To assess the evolution of PI-RADS ≥ 3 lesions on prostate MRI following PAE.
- To determine if PAE impacts the PI-RADS classification of pre-existing lesions.
Main Methods:
- Retrospective analysis of 18 patients who underwent PAE.
- Inclusion criteria: pre-PAE MRI with at least one PI-RADS ≥ 3 lesion.
- Assessment of PI-RADS score changes, infarction, and prostate volume on follow-up MRI.
Main Results:
- No new PI-RADS ≥ 3 lesions appeared post-PAE; no lesions were upgraded.
- PI-RADS 5 lesions were downgraded to PI-RADS 1.
- PI-RADS 4 and PI-RADS 3 lesions showed stability or downgrading, with some reaching PI-RADS 1 status.
Conclusions:
- PI-RADS ≥ 3 lesions on prostate MRI tend to stabilize or downgrade after PAE.
- Radiopathological correlation is necessary to validate PI-RADS scoring reliability post-PAE.
- PAE does not imply a cure for potential prostate cancer.
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