Abstract
Purpose: The purpose of this study was to validate the second version of the Prostate Imaging Reporting and Data System (PI-RADSv2) scores in predicting positive in-bore MRI-guided targeted prostate biopsy results across different non-university related institutions. The study focuses on PI-RADS v2 scoring because during the study period, PI-RADS v2.1 had not been released. Materials and Methods: This was a retrospective review of 147 patients who underwent multiparametric magnetic resonance imaging (mpMRI) of the pelvis followed by in-bore MRI-guided targeted prostate biopsy from December 2014 to May 2018. All lesions on mpMRI were rated according to PI-RADS v2 criteria. PI-RADS v2 scores were then compared to MR-guided biopsy results and pre-biopsy PSA values. Results: Prostate Cancer (PCa) was detected in 54% (80/147) of patients, with more prostate cancer being detected with each subsequent increase in PI-RADS scores. Specifically, biopsy results in patients with PI-RADS 3, 4, and 5 lesions resulted in PCa in 25.6% (10/39), 58.1% (33/55), and 86.0% (37/43) respectively. Clinically significant PCa (Gleason score ≥7) was detected in 17.9% (7/39), 52.7% (29/55), and 72% (31/43) of cases for PI-RADS 3, 4, and 5 lesions respectively. When the PI-RADS scoring and biopsy results were compared across different institutions, there was no difference in the PI-RADS scoring of lesions or in the positive biopsy rates of the lesions. The sensitivity, specificity, PPV, and NPV for PI-RADS 3-4 lesions were also not statistically different across the institutions for detecting Gleason 7 or greater lesions. Conclusion: Our results agree with prior studies that higher PI-RADS scores are associated with the presence of clinically significant PCa and suggest prostate lesions with PI-RADS scores 3-5 have sufficient evidence to warrant targeted biopsy. The comparison of PI-RADS score across different types of non-university practices revealed no difference in scoring and biopsy outcome, suggesting that PI-RADS v2 can be easily applied outside of the university medical center setting. Clinical Relevance: PI-RADS v2 can be applied homogeneously in the non-university setting without significant difference in outcome.
Highlights
Improvements in MRI technology have led to increased utilization of multiparametric MRI in detecting and characterization of prostate lesions [1]
In order to standardize the reporting of multiparametric MRI (mpMRI), the European Society of Urogenital Radiology (ESUR) introduced the Prostate Imaging Reporting and Data System (PI-RADS) in 2012 [7]
Our study population demonstrated an average age of 67.2 years with a mean prostate-specific antigen (PSA) value of 18.2 at time of biopsy. 10 lesions were scored as PI-RADS 2, 39 lesions as PI-RADS 3, 55 lesions as PI-RADS 4, and 43 lesions as PI-RADS 5. 80 (54.4%) of the lesions biopsied were located in the peripheral zone and 35 (23.8%) were located in the transitional zone
Summary
Improvements in MRI technology have led to increased utilization of multiparametric MRI (mpMRI) in detecting and characterization of prostate lesions [1]. Published results from the PRECISION trial found that mpMRI followed by MRI-targeted biopsy diagnosed more clinically significant prostate cancer than standard transrectal ultrasonography-guided (TRUS) biopsy in men at risk for prostate cancer who have not undergone a previous biopsy [2]. The update in 2015 to PI-RADS v2 simplified the analysis and implementation so that it can be more widely accepted [8, 9] This simplified scoring system combines T2 appearance of the lesion, apparent diffusion coefficient and diffusionweighted signal intensity, and early dynamic contrast enhancement to estimate the level of probability that a lesion harbors cancer without significantly altering the predictive capability from version 1 [9, 10]. While there has been validation of PI-RADS v2 for initial diagnosis, these results have been obtained predominantly in university-associated major academic centers [12-18]. Validation of PIRADS v2 for initial diagnosis have not been reported in non-university associated academic or private practice setting
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