The role of mpMRI in qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy

Łukasz Nyk,Wojciech Malewski,Piotr Kryst,Tomasz Ząbkowski,Aneta Andrychowicz,Omar Tayara

doi:10.1186/s12894-021-00850-3

Abstract

BackgroundTo investigate the role of mpMRI and high PIRADS score as independent triggers in the qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy.MethodsBetween January 2017 and June 2019, 494 laparoscopic radical prostatectomies were performed in our institution, including 203 patients (41.1%) with ISUP 1 cT1c-2c PCa on biopsy. Data regarding biopsy results, digital rectal examination, PSA, mpMRI and postoperative pathological report have been retrospectively analysed.ResultsIn 183 cases (90.1%) mpMRI has been performed at least 6 weeks after biopsy. Final pathology revealed ISUP Gleason Grade Group upgrade in 62.6% of cases. PIRADS 5, PIRADS 4 and PIRADS 3 were associated with Gleason Grade Group upgrade in 70.5%, 62.8%, 48.3% of patients on final pathology, respectively. Within PIRADS 5 group, the number of upgraded cases was statistically significant.ConclusionsPIRADS score correlates with an upgrade on final pathology and may justify shared decision of radical treatment in patients unwilling to repeated biopsies. However, the use of PIRADS 5 score as a sole indicator for prostatectomy may result in nonnegligible overtreatment rate.

Highlights

To investigate the role of multiparametric resonance imaging (mpMRI) and high prostate imaging and report and data system (PIRADS) score as independent triggers in the qualification of patients with International Society of Urological Pathology (ISUP) 1 prostate cancer on biopsy to radical prostatectomy
Final pathology revealed ISUP Gleason Grade Group upgrade in 62.6% of cases
PIRADS 5, PIRADS 4 and PIRADS 3 were associated with Gleason Grade Group upgrade in 70.5%, 62.8%, 48.3% of patients on final pathology, respectively

Summary

Introduction

To investigate the role of mpMRI and high PIRADS score as independent triggers in the qualification of patients with ISUP 1 prostate cancer on biopsy to radical prostatectomy. Prostate cancer is diagnosed in 1.1 million men annually [1]. The introduction of prostate specific antigen (PSA) screening attributes to common low risk disease diagnoses [2]. Active surveillance (AS) is a recommended approach in low risk prostate cancer and selected cases of intermediate disease [3]. It aims to avoid serious complications of radical treatments such as incontinence or erectile dysfunction. AS studies report high cancer specific survival rates of up to 99% at 15 years [4].

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