An Analysis of MRI-Fusion Prostate Biopsy Results in PI-RADS 3 MRI Findings in a Cohort of Men in a Community Hospital Setting

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Introduction: With the advent of multiparametric MRI (mpMRI), clinicians added an important tool for helping to decide whether a man should undergo a prostate biopsy. The MRI PI-RADS system stratifies the risk of finding cancer on prostate biopsy. PI-RADS 3 lesions often prove to be a diagnostic challenge, and many men are advised not to proceed with a biopsy based on this finding. The goal of our paper was to evaluate the likelihood of finding cancer of clinical significance in this group. Methods: A retrospective 4-year data and quality analysis was performed of 312 evaluable men undergoing prostate MRI. Of the subset with scores of PI-RADS 3 who underwent biopsy (N = 32), 100 percent were biopsied using an MRI-guided fusion technique, greatly raising the likelihood that the MRI lesion was, in fact, the area sampled. Results: A total of 34% of the men with PI-RADS 3 lesions were found to have Grade Group ≥ 1, with 15.6 % demonstrating Grade Group ≥ 2. In the men with cancer, we analyzed and report the relationship to age, ethnicity, PSA density, and the presence or absence of cribriform findings. Conclusions: We found that many men with PI-RADS 3 findings on multiparametric MRI do, in fact, have clinically significant prostate cancer. We suggest that many factors (such as rate of rise of PSA over time, family history, and rectal examination findings) be considered in addition to the MRI PI-RADS score to advise whether or not to proceed with a biopsy of the prostate. Our findings, from a single, large, community hospital with a diverse ethnic makeup, parallel the findings of large trials done at academic centers of excellence. This demonstrates that comparable diagnostic mpMRI/biopsy quality may be found in the community setting.