Abstract
The use of multi-parametric magnetic resonance imaging (mpMRI) in conjunction with the Prostate Imaging Reporting and Data System (PI-RADS) is standard practice in the diagnosis, surveillance, and staging of prostate cancer. The risk associated with lesions graded at a PI-RADS score of 3 is ambiguous. Further characterization of the risk associated with PI-RADS 3 lesions would be useful in guiding further work-up and intervention. This study aims to better characterize the utility of PI-RADS 3 and associated risk factors in detecting clinically significant prostate cancer. From a prospectively maintained IRB-approved dataset of all veterans undergoing mpMRI fusion biopsy at the Southeastern Louisiana Veterans Healthcare System, we identified a cohort of 230 PI-RADS 3 lesions from a dataset of 283 consecutive UroNav-guided biopsies in 263 patients from October 2017 to July 2020. Clinically significant prostate cancer (Gleason Grade ≥ 2) was detected in 18 of the biopsied PI-RADS 3 lesions, representing 7.8% of the overall sample. Based on binomial analysis, PSA densities of 0.15 or greater were predictive of clinically significant disease, as was PSA. The location of the lesion within the prostate was not shown to be a statistically significant predictor of prostate cancer overall (p = 0.87), or of clinically significant disease (p = 0.16). The majority of PI-RADS 3 lesions do not represent clinically significant disease; therefore, it is possible to reduce morbidity through biopsy. PSA density is a potential adjunctive factor in deciding which patients with PI-RADS 3 lesions require biopsy. Furthermore, while the risk of prostate cancer for African-American men has been debated in the literature, our findings indicate that race is not predictive of identifying prostate cancer, with comparable Gleason grade distributions on histology between races.
Highlights
The use of multiparametric magnetic resonance imaging in the diagnosis of prostate cancer has increased over the past decade, due to the potential of this technology to increase detection rates of clinically significant prostate cancer and minimize overdiagnosis of low-risk disease [1,2]
There were 67 biopsies that contained exclusively Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions without additional higher scored PI-RADS lesions within the prostate. Considering this subset of biopsies, there were 14 instances of clinically significant prostate cancer detected in the template biopsies without clinically significant disease within the region-of-interest biopsies
We report that 7.8% of biopsied PI-RADS 3 lesions were found to contain clinically significant prostate cancer
Summary
The use of multiparametric magnetic resonance imaging (mpMRI) in the diagnosis of prostate cancer has increased over the past decade, due to the potential of this technology to increase detection rates of clinically significant prostate cancer and minimize overdiagnosis of low-risk disease [1,2]. System (PI-RADS) was developed to standardize the imaging acquisition and reporting of prostate mpMRI findings in order to aid in providing clinicians with the ability to make treatment decisions and guidelines. PI-RADS v2 was developed to further simplify and standardize the acquisition, interpretation, and reporting of prostate mpMRI exams, with the intention that the system should evolve according to clinical consensus [5,6]. There is significant variability between reported prevalence and clinically significant prostate cancer detection among studies in the existing literature [9]
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