Prostate Imaging Reporting And Data System Version 2 Score Research Articles

MP08-10 PROSPECTIVE EVALUATION OF CANCER DETECTION RATES OF THE PROSTATE IMAGING REPORTING AND DATA SYSTEM VERSION 2

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 2017MP08-10 PROSPECTIVE EVALUATION OF CANCER DETECTION RATES OF THE PROSTATE IMAGING REPORTING AND DATA SYSTEM VERSION 2 Sherif Mehralivand, Sandra Bednarova, Joanna Shih, Francesca Mertan, Sonia Gaur, Maria Merino, Bradford Wood, Peter Pinto, Peter Choyke, and Baris Turkbey Sherif MehralivandSherif Mehralivand More articles by this author , Sandra BednarovaSandra Bednarova More articles by this author , Joanna ShihJoanna Shih More articles by this author , Francesca MertanFrancesca Mertan More articles by this author , Sonia GaurSonia Gaur More articles by this author , Maria MerinoMaria Merino More articles by this author , Bradford WoodBradford Wood More articles by this author , Peter PintoPeter Pinto More articles by this author , Peter ChoykePeter Choyke More articles by this author , and Baris TurkbeyBaris Turkbey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.297AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) was introduced in 2015. The likelihood of harboring clinically significant prostate cancer (CS PCa) on multiparametric MRI (mpMRI) is assessed on a five-point scale. We prospectively evaluated cancer detection rates (CDRs) of PI-RADSv2 scores using the new International Society of Urological Pathology (ISUP) grading group system as the gold standard. METHODS From May 2015-May 2016, 963 patients underwent prostate mpMRI including T2 weighted (T2W), diffusion weighted, apparent diffusion coefficient maps, high b value (1500-2000s/mm2) and dynamic contrast enhancement sequences. 339/963 patients underwent MRI/US fusion guided biopsy. The highest Gleason score per target lesion was given an ISUP score. Lesion-based CDRs for all PCa and CS PCa (ISUP≥2, ≥Gleason 3+4) were calculated for each PI-RADSv2 score in the entire prostate, peripheral (PZ) and transition zones (TZ). RESULTS CDRs for all and CS PCa for each PIRADSv2 score are shown in Figure 1. PI-RADSv2 score 5 had the highest CDRs for all and CS PCa at 87% and 72%, respectively. PI-RADSv2 score 4 had unexpectedly low CDR for both all and CS PCa (39% and 22%, respectively). Specifically, in the PZ, the CDR of T2W PI-RADSv2 score 4 was significantly higher than the CDR of overall PI-RADSv2 score 4 for all PCa (48% vs. 37%, p=0.01) and CS PCa (33% vs 23%, p=0.002) (Figure 2). CONCLUSIONS CDRs increase with higher PI-RADSv2 scores. CDR of PI-RADSv2 score 4 is low due to a high false positive rate. In the PZ, T2W scores combined with DWI scores, rather than DWI scores alone may improve the CDR for PI-RADSv2 score 4 lesions. Future versions of PI-RADS should take this into account. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e94-e95 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sherif Mehralivand More articles by this author Sandra Bednarova More articles by this author Joanna Shih More articles by this author Francesca Mertan More articles by this author Sonia Gaur More articles by this author Maria Merino More articles by this author Bradford Wood More articles by this author Peter Pinto More articles by this author Peter Choyke More articles by this author Baris Turkbey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prostate Imaging Reporting and Data System, Version 2, Assessment Categories and Pathologic Outcomes in Patients With Gleason Score 3 + 4 = 7 Prostate Cancer Diagnosed at Biopsy.

The purpose of this study is to assess associations between Prostate Imaging Reporting and Data System, version 2 (PI-RADSv2), categories and the presence of a tumor with a Gleason score (GS) of 4 + 3 = 7 or greater or the presence of extraprostatic extension (EPE) at radical prostatectomy (RP) in patients with a GS 3 + 4 = 7 tumor at biopsy. A total of 81 men with GS 3 + 4 = 7 prostate cancer diagnosed by transrectal ultrasound-guided biopsy underwent multiparametric MRI and RP between 2012 and 2015. Two blinded radiologists assessed multiparametric MR images and assigned PI-RADSv2 assessment categories (categories 1-5) with the use of sector maps, which were compared with regard to the location of the tumor, the GS, and the presence of EPE at RP. Comparisons were performed between groups with the use of chi-square and multivariate analysis. Diagnostic accuracy was assessed using ROC curve analysis, and localization was compared using the Fisher exact test. A total of 53.1% of men (43/81) had EPE, and 21.0% (17/81) had GS 4 + 3 = 7 prostate cancer after RP, whereas 2.5% of men (2/81) had their tumors downgraded to GS 3 + 3 = 6. No statistically significant difference in patient age, prostate specific antigen level, or clinical stage existed between groups (p > 0.05). PI-RADSv2 assessment categories were significantly higher for GS 4 + 3 = 7 tumors (p = 0.03). PI-RADSv2 showed moderate accuracy for the diagnosis of GS 4 + 3 = 7 tumors (AUC, 0.65; 95% CI, 0.54-0.77), with a category of 4 or higher having a sensitivity and specificity for diagnosis of 94.1% and 23.4%, respectively. No patient with a PI-RADSv2 category lower than 3 had a GS 4 + 3 = 7 tumor. Accuracy of tumor localization ranged from 86.4% to 92.6%, with 88.2% of errors (15/17) occurring in GS 3 + 3 = 6 or GS 3 + 4 = 7 tumors (p = 0.30). PI-RADSv2 categories were noted to be higher when EPE was present (p < 0.001). Interobserver agreement was moderate (κ = 0.43). For GS 3 + 4 = 7 cancers detected at transrectal ultrasound-guided biopsy, higher PI-RADSv2 assessment categories are associated with upgrading to GS 4 + 3 = 7 cancer and with the presence of EPE after RP. A PI-RADSv2 score of 3 or higher was 100% sensitive for diagnosing GS 4 + 3 = 7 tumors.

“In-bore” MRI-guided Prostate Biopsy Using an Endorectal Nonmagnetic Device: A Prospective Study of 70 Consecutive Patients

We investigated the diagnostic performance of in-bore endorectal magnetic resonance imaging-guided biopsy (MRI-GB) with a 1.5-T MRI scanner using a 32-channel coil in patients with suspected prostate cancer (PCa). Seventy patients with≥ 1 suspicious area found on the preliminary multiparametric MRI scan were enrolled. The index lesion was defined as the lesion with the greatest Prostate Imaging Reporting and Data System, version 2 (PIRADS-v2), score. MRI-GBs were performed with a nonmagnetic biopsy device, needle guide, and titanium double-shoot biopsy gun with dedicated software for needle tracking. Clinically significant PCa was defined as the presence of Gleason score≥ 7 in the biopsy specimen. Seventy index lesions were scheduled for MRI-GB. The median PIRADS-v2 score and the median number of cores per patient was 4 of 5 (interquartile range, 3-5) and 2 (interquartile range, 1-3), respectively. The PCa detection rate was 45.7%. Of the 70 patients, 24 (75%) had clinically significant PCa, with a significant correlation between the PIRADS-v2 score and the Gleason score in theMRI-GB cores (r= 0.839; 95% confidence interval, 0.535-0.951; P= .003). According to the PIRADs-v2 scheme, the proportion of PCa in the central and anterior regions of the gland was greater in the entire population and in the subgroup of patients with a history of negative transrectal ultrasound-guided biopsy findings (P≤ .01 for all). On multivariate analysis, a PIRADS-v2 score of 5 of 5 correlated significantly with the likelihood of PCa at biopsy (hazard ratio, 4.69; 95% confidence interval, 0.92-23.74; P= .04). No major complications were recorded. MRI-GB has a high detection rate for PCa, especially for lesions located in the central and anterior regions of the prostate.

Prostate magnetic resonance imaging findings in patients treated for testosterone deficiency while on active surveillance for low-risk prostate cancer

ObjectiveTo investigate the multiparametric prostate magnetic resonance imaging (mpMRI) findings in patients treated with testosterone replacement therapy (TRT) while on active surveillance for low-risk prostate cancer. MethodsWe retrospectively reviewed 12 patients who underwent mpMRI before and after TRT while on active surveillance. Changes in serum testosterone level, prostate-specific antigen (PSA), prostate biopsy findings, prostate volume, and Prostate Imaging Reporting and Data System Version 2 (PI-RADSv2) score before and after TRT were summarized. ResultsAfter TRT, there was a significant increase in serum testosterone (516.5ng/dl vs. 203.0ng/dl), PSA (4.2ng/ml vs. 3.3ng/ml), and prostate volume (55.2cm3 vs. 39.4cm3). In total, 2 patients had biopsy progression during the study period. The PI-RADSv2 scores before and after TRT were unchanged in 10/12 patients; none of these demonstrated biopsy progression on post-TRT. The PI-RADSv2 scores increased after TRT in 2/12 patients; both showed Gleason score upgrade on follow-up biopsy. Of these 2 patients, 1 patient underwent radical treatment due to clinical progression. The area under the curve for detecting biopsy progression calculated from PI-RADSv2 score after TRT was 0.90, which was better than that calculated from post-TRT PSA level (0.48). ConclusionsAfter TRT, mpMRI findings remained stable in patients without biopsy progression, whereas PI-RADSv2 score increase was identified in patients with Gleason score upgrade on follow-up biopsy.

Prospective Evaluation of the Prostate Imaging Reporting and Data System Version 2 for Prostate Cancer Detection

Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) was developed to standardize the interpretation and reporting of multiparametric prostate magnetic resonance imaging and provide guidelines for biopsy of multiparametric magnetic resonance imaging findings. We prospectively evaluated the cancer detection rate at each overall PI-RADSv2 score. This prospective study included 62 consecutive patients with 116 lesions who underwent multiparametric prostate magnetic resonance imaging at 3T with PI-RADSv2 evaluation and subsequent targeted magnetic resonance imaging/transrectal ultrasound fusion guided biopsy and concurrent 12-core systematic prostate biopsy between May and September 2015. Median patient age and prostate specific antigen values were 65.5 years (range 50.3 to 76.6) and 7.10 ng/ml (range 0.47 to 863.0), respectively. Mean lesion size was 12.7mm overall. Lesion based cancer detection rates for all tumors and for Gleason 3+4 or greater tumors at each PI-RADSv2 score were calculated. Univariate analysis was performed to assess differences in the cancer detection rate among PI-RADSv2 scores. A total of 116 lesions in 62 patients were evaluated prospectively (0PI-RADS 1, 18 PI-RADS 2, 19 PI-RADS 3, 47 PI-RADS 4, 32 PI-RADS 5), and the patients underwent magnetic resonance/transrectal ultrasound fusion guided biopsy and systematic biopsy. Histopathology revealed 55 of 116 (47.4%) cancers (17 Gleason 3+3, 16 Gleason 3+4, 6 Gleason 4+3, 12 Gleason 4+4, 3Gleason 4+5 and 1 Gleason 5+4). Based on targeted biopsy on a per lesion basis, the overall cancer detection rates of PI-RADS 2, 3, 4 and 5 scores for all tumors was 22.2%, 15.8%, 29.8% and 78.1%, respectively. The cancer detection rate of PI-RADS 2, 3, 4 and 5 scores for Gleason 3+4 or greater tumors was 5.6%,0%, 21.3% and 75%, respectively. Differences in the cancer detection rate between overall PI-RADS 4 and 5 scores were significant (p <0.001 for Gleason greater than 3+3 and Gleason 3+4 or greater cancers). A PI-RADS score of 5 had the highest prospective cancer detection rate (78%). A PI-RADS score of 4 had only a 30% cancer detection rate, which is lower than expected. Surprisingly, no or few significant cancers were detected at a PI-RADS score of 3 (16%). These early prospective data suggest that current criteria result in a high false-positive rate that lowers the cancer detection rate. Therefore, stricter criteria may be needed in the future to decrease false-positives and increase the cancer detection rate for PI-RADS scores of 3, 4 and 5.

Prediction of biochemical recurrence after radical prostatectomy with PI-RADS version 2 in prostate cancers: initial results.

To determine whether the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) helps predict biochemical recurrence (BCR) after radical prostatectomy for prostate cancer (PCa). We included 158 patients with PCa who underwent magnetic resonance imaging (MRI) and radical prostatectomy (RP). Clinical (prostate-specific antigen, greatest percentage of core, and percentage of positive core number), PI-RADSv2 score on MRI, and surgical parameters (Gleason score, extracapsular extension, seminal vesicle invasion, and tumour volume) were investigated. Univariate and multivariate analyses using Cox's proportional hazards model were performed to assess parameters predictive of BCR (two consecutive prostate specific antigens ≥0.2ng/ml). Kaplan-Meier survival curves were analyzed. The rate of BCR was 13.3% (21/158) after surgery (median follow-up, 25months; range, 12-36). No subject with a PI-RADS score <4 had BCR. In univariate analysis, all parameters were significant for BCR (p < 0.05), except seminal vesicle invasion (p = 0.254). Meanwhile, PI-RADS score was the only independent parameter for BCR in multivariate analysis (p < 0.05). Two-year, BCR-free survival post-RP was significantly lower for PI-RADS ≥4 (84.7-85.5%) than for PI-RADS <4 (100%; p < 0.05). As a preoperative imaging tool, PI-RADSv2 may be useful to predict BCR after radical prostatectomy for PCa. • No subject with PI-RADS <4 had BCR after RP • PI-RADSv2 was the only predictor of BCR in multivariate analysis • Two-year, BCR-free survival following RP was lower for PI-RADS≥4 than for PI-RADS<4 • Inter-rater agreement was good for PI-RADS ≥4 or not.

Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference.

To evaluate the recommendations for multiparametric prostate MRI (mp-MRI) interpretation introduced in the recently updated Prostate Imaging Reporting and Data System version 2 (PI-RADSv2), and investigate the impact of pathologic tumour volume on prostate cancer (PCa) detectability on mpMRI. This was an institutional review board (IRB)-approved, retrospective study of 150 PCa patients who underwent mp-MRI before prostatectomy; 169 tumours ≥0.5-mL (any Gleason Score [GS]) and 37 tumours <0.5-mL (GS ≥4+3) identified on whole-mount pathology maps were located on mp-MRI consisting of T2-weighted imaging (T2WI), diffusion-weighted (DW)-MRI, and dynamic contrast-enhanced (DCE)-MRI. Corresponding PI-RADSv2 scores were assigned on each sequence and combined as recommended by PI-RADSv2. We calculated the proportion of PCa foci on whole-mount pathology correctly identified with PI-RADSv2 (dichotomized scores 1-3 vs. 4-5), stratified by pathologic tumour volume. PI-RADSv2 allowed correct identification of 118/125 (94%; 95 %CI: 90-99%) peripheral zone (PZ) and 42/44 (95%; 95 %CI: 89-100%) transition zone (TZ) tumours ≥0.5mL, but only 7/27 (26%; 95 %CI: 10-42%) PZ and 2/10 (20%; 95 %CI: 0-52%) TZ tumours with a GS ≥4+3, but <0.5mL. DCE-MRI aided detection of 4/125 PZ tumours ≥0.5mL and 0/27 PZ tumours <0.5mL. PI-RADSv2 correctly identified 94-95% of PCa foci ≥0.5mL, but was limited for the assessment of GS ≥4+3 tumours ≤0.5mL. DCE-MRI offered limited added value to T2WI+DW-MRI. • PI-RADSv2 correctly identified 95% of PCa foci ≥0.5mL • PI-RADSv2 was limited for the assessment of GS ≥4+3 tumours ≤0.5mL • DCE-MRI offered limited added value to T2WI+DW-MRI.