MP40-18 TITLE: PIRADS 3 RADIOLOGIC “GREY ZONE” - WHAT PROPORTION OF MEN WHO HAVE PIRADS 3 LESIONS REPORTED ON MP-MRI HAVE PROSTATE CANCER?

Abstract

You have accessJournal of UrologyProstate Cancer: Detection & Screening III1 Apr 2018MP40-18 TITLE: PIRADS 3 RADIOLOGIC “GREY ZONE” - WHAT PROPORTION OF MEN WHO HAVE PIRADS 3 LESIONS REPORTED ON MP-MRI HAVE PROSTATE CANCER? Daniel Costello, Paul Cathcart, Cameron Parkin, Mark Frydenberg, Daniel Moon, Justin Peters, Oussama El Hage, Ben Challacombe, and Anthony Costello Daniel CostelloDaniel Costello More articles by this author , Paul CathcartPaul Cathcart More articles by this author , Cameron ParkinCameron Parkin More articles by this author , Mark FrydenbergMark Frydenberg More articles by this author , Daniel MoonDaniel Moon More articles by this author , Justin PetersJustin Peters More articles by this author , Oussama El HageOussama El Hage More articles by this author , Ben ChallacombeBen Challacombe More articles by this author , and Anthony CostelloAnthony Costello More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1285AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric MRI (MP-MRI) of the prostate is used regularly in evaluation prior to prostate cancer biopsy. MRI can identify targetable areas in the prostate for biopsy to enhance diagnostic yield. A risk grading scale PIRADS I & II has superseded the Likert scale assessment for imaging prostatic abnormality suggestive of cancer. A scale of PIRADS 1 to 5 is used and the higher the PIRADS score the more likely that the abnormality on MRI harbours significant cancer. Uncertainty exists with management of men with PIRADS 3 scores, which represent radiographic lesions where the presence of clinically significant cancer is equivocal. Does a report of PIRADS 3 mandate a prostate biopsy? What is the likelihood of a significant cancer diagnosis if PIRADS 3 is identified? As a rider to this quandary what is the most appropriate definition of significant prostate cancer? Some authors (PROMIS) discount low volume Gleason 3 + 4 cancer as clinically significant and suggest those men are appropriate for an active surveillance program. Some Gleason 3 + 4 cancers do not have MRI identifiable abnormality. Some 3 + 4 disease however, harbours lethal phenotype. METHODS 2767 prostate MP-MRIs performed on men presenting with elevated PSAs at Guys and St Thomas Hospital London and Melbourne Bridge Road Radiology between 2014 and 2017 were reviewed (856 from London, 1911 from Melbourne). We identified 196 patients with a PIRADS 3 abnormality with confirmatory histology on prostate biopsy. Data obtained:- PSA density.- Demographic data.- Prostate biopsy result (transrectal or transperineal route) with maximum cancer core length and gleason grade. RESULTS - 196 men (104 London, 92 Melbourne) with PIRADS 3 scores underwent prostate biopsy from 2005 - 2017.- Mean PSA 6.67 ng/ml (7.12 ng/ml London, 6.16 ng/ml Melbourne).- Mean prostate volume 43.41 cc assessed by MRI (40.58 cc London, 46.61 cc Melbourne).- Mean PSA density 0.19 ng/ml/cc (0.22 ng/ml/cc London, 0.16 ng/ml/cc Melbourne).- Mean maximum cancer core length 4.3mm (3.1 mm London, 5.5 mm Melbourne).- Biopsy results detailed in table 1. CONCLUSIONS It would seem prudent with our present knowledge to consider biopsy for all men with a PIRADS 3 report. The significance of gleason 3 + 4 disease on biopsy needs further assessment. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e526 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniel Costello More articles by this author Paul Cathcart More articles by this author Cameron Parkin More articles by this author Mark Frydenberg More articles by this author Daniel Moon More articles by this author Justin Peters More articles by this author Oussama El Hage More articles by this author Ben Challacombe More articles by this author Anthony Costello More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...