Prospective Evaluation of PI-RADS™ Version 2 Using the International Society of Urological Pathology Prostate Cancer Grade Group System

Abstract

The cancer detection rate increases with higher PI-RADS, version 2 categories.

Multi‐institutional nomogram predicting benign prostate pathology on magnetic resonance/ultrasound fusion biopsy in men with a prior negative 12‐core systematic biopsy

“…Our multi-institutional nomogram incorporates age, PSA, MRI-derived prostate volume, and PI-RADS score for maximum predictive accuracy. 25 Although a lesion with a PI-RADS score of 5 should certainly be biopsied, our nomogram can enhance the ability to predict benign pathology and prevent unnecessary biopsies not only for lesions with a PI-RADS score of 3 but also for lesions with a PI-RADS score of 4. In a prospective study of 62 patients using PI-RADS version 2, 0% of patients with a PI-RADS score of 3 had clinically significant cancer found.…”

“…6 A recent, large, prospective evaluation of PI-RADS version 2 demonstrated that cancer detection rates with PI-RADS scores of 3, 4, and 5 were 24.8%, 39.1%, and 86.9%, respectively; this suggested that the majority of those with a PI-RADS score of 4 will not have cancer found after MR/US FB. 25 Although a lesion with a PI-RADS score of 5 should certainly be biopsied, our nomogram can enhance the ability to predict benign pathology and prevent unnecessary biopsies not only for lesions with a PI-RADS score of 3 but also for lesions with a PI-RADS score of 4. The use of the URMC1UAB 345 nomogram has the potential to significantly reduce health care costs and the morbidity associated with unnecessary prostate biopsies, even in the setting of positive mpMRI findings.…”

Prospective comparison of PI‐RADS version 2 and qualitative in‐house categorization system in detection of prostate cancer

“…Nonetheless, it is difficult to isolate the advantage that familiarity with the in‐house system provides. It is important to note, however, that our PI‐RADSv2 TDRs are in broad agreement with other recent PI‐RADSv2 validation data . Finally, our study cohort consisted of patients who underwent MRI/TRUS fusion‐guided biopsy, which is inherently a limited gold standard compared to a radical prostatectomy population.…”

“…The patient population in this study is part of a large prospective PI‐RADSv2 validation study population. Previous reports on this group include establishing the correlation of PI‐RADSv2 scoring system with the International Society of Urological Pathology (ISUP) Prostate Cancer Grade Group System . Here we report a prospective comparison of PI‐RADSv2 and an in‐house method of MRI interpretation.…”

Reply to Evaluation of magnetic resonance imaging and targeted biopsy: The difficulty of finding the right reference standard

“…Finally, we acknowledge that MRI can render false‐positive findings. The practice of labeling Prostate Imaging Reporting and Data System 3 lesions as positive should be called into question because of the consistently low clinically significant cancer detection rates within these areas . Moreover, we have previously shown that false positivity can also occur in the setting of inflammatory conditions such as granulomatous prostatitis .…”