Presentation Authors: Andrew Ng*, Robert Moldwin, New Hyde Park, NY
Introduction: We examined pelvic multiparametric MRI (mpMRI) findings in the male CP/CPPS population detailing prostatic inflammatory events with and without urinary tract infections.
Methods: We retrospectively reviewed the records of patients with a diagnosis of CP/CPPS evaluated at our facility between July 2012 and June 2018. We obtained information including: age, race, BMI, duration of symptoms, treatments applied, past medical history, urine culture, PSA. We reviewed pelvic MRI data including protocol type and other pathologies related to the prostate.
Results: A total of 104 patients were diagnosed with CP/CPPS who also received an MRI of the pelvis, of whom 32 had a mpMRI. â€œChronic prostatitisâ€ was identified on 66% mpMRI reports (21). This was characterized by terms such as: (1) diffuse, heterogeneous, low T2 signal (2) low apparent diffusion coefficient (ADC) and (3) early enhancement. mpMRI that indicated chronic prostatitis had a mean PIRADS score of 2.63 (1-5) compared to a score of 1.6 (1-2) in those that did not.81% of patients (17) had mpMRI evidence of prostatic inflammation in the absence of a history of urinary tract infection. 48% of patients with prostatic inflammation on mpMRI (10) had positive physical exam findings (i.e. palpable muscle spasm or trigger points in the pelvic floor) and an average Genitourinary Pain Index (GUPI) of 18. 46% of patients without prostatic inflammation on mpMRI (5) had positive physical exam findings and an average GUPI of 22. There were no statistical difference in exam findings between patients who had evidence of inflammation and those who had no evidence on mpMRI (p= 0.91).
Conclusions: CP/CPPS is an entity that affects a large portion of men. Almost two-thirds of our patients were found to have mpMRI evidence of inflammation as defined by heterogeneous, low T2 signal with diffuse enhancement, and low ADC. There were no physical exam findings to differentiate between those with or without inflammation on mpMRI. These results may reveal a novel phenotype of CP/CPPS that has an inflammatory, noninfectious etiology.