Clinical implementation PI-RADS v2.1: Detection rate of clinically significant prostate cancer in PI-RADS 4 and 5 categories–The Real-life data

Abstract

Background Clinically significant prostate cancer (csPCa) diagnosis and risk assessment have been improved after utilizing multiparametric magnetic resonance imaging (mp-MRI). To access the global standardization in mp-MRI acquisition and interpretation, Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) was developed and showed good overall performance in the detection of csPCa, particularly among higher categories. This study aimed to identify the csPCa detection rate (DR) among PI-RADS 4 and 5 categories. Methods The study population includes 76 (109 lesions) biopsy naïve patients with PI-RADS scores of 4 and 5 in prebiopsy mp-MRI who underwent systematic biopsy combined with cognitive targeted biopsy (cog-MRGB) between March 2020 and September 2022. Baseline characteristics and pathological findings were compared based on csPCa and PI-RADS scores. In addition, prostate cancer (PCa) and csPCa DRs were determined overall and according to the PI-RADS categories and the prostate zones. Results Among the study population, 35 men (46.10%) (51 lesions) and 41 men (53.90%) (58 lesions) belonged to PI-RADS scores of 4 and 5, respectively. The age of participants was 68.74 years in mean (with a standard deviation [SD] 8.83). Moreover, the level of prostate-specific antigen (PSA) was 9.47 ng/ml in the median (interquartile range [IQR] 6.20-19.79), along with the median prostate volume of 45.50 (IQR 35.00–76.00) ml. Individuals suffering from csPCa had statistically significant higher levels of PSA, PI-RADS categories, and lesions located on the prostate peripheral zone (PZ), as well as larger lesions and smaller prostate. The overall PCa and csPCa DRs were 57.90% (44 patients) and 44.70% (34 patients). Furthermore, csPCa DR stratified by PI-RADS scores and prostate zones was 68.30% in PI-RADS 5, 17.10% in PI-RADS 4, 54.90% in the PZ, and 34.30% in the prostate transition zone (TZ). Conclusions Our real-life data from a Middle Eastern developing country showed that the clinical implementation of PI-RADS v2.1 in combination with cog-MRGB yielded an acceptable overall PCa and csPCa DR, particularly among PI-RADS scores of 5. However, the results provided notable limitations on the PI-RADS score of 4 and TZ.