Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

Abstract

Objectives To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2.Materials and Methods In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa).Results Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density.Conclusions Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

Análise comparativa entre resultados de exames complementares e peça cirúrgica final de pacientes submetidos a prostatovesiculectomia radical

“…Comparando-se biópsia prostática e PI-RADS determinado pela RMN pélvica (p=0,005), verificou-se que 90,9% dos pacientes EG 6 (3+3) obtiveram PI-RADS 3 ou 4, enquanto 89,1% dos pacientes de EG de 7 (3+4 ou 4+3) possuíram PI-RADS 4 ou 5, e 93,7% dos pacientes cujo EG foi de 8 (4+4) ou 9 (4+5) receberam PI-RADS 4 ou 5, o que aponta para uma importante acurácia da RMN em trazer resultados fidedignos acerca do CaP, de modo a beneficiar sua estratificação de risco, o que vem sendo respaldado por estudos recentes (VIANA et al, 2019). Avaliando-se a associação entre EG da biópsia prostática e presença de metástases em linfonodos da peça cirúrgica final (p=0,001), constatou-se uma incidência 16,30 vezes superior da metástase entre os pacientes cujo EG da biópsia foi de 8 (4+4) ou 9 (4+5) em relação aos pacientes de EG da biópsia de 6 (3+3).…”

A novel screening strategy for clinically significant prostate cancer in elderly men over 75 years of age

“…In a report from China, PSAD, TRUS findings, and the prostate imaging reporting and data system (PI-RADS) score were factors that could be used to predict CSPC in elderly patients over 75 years, and PI-RADS version 2 score has been found to be very useful in predicting CSPC. 14 15 16 A PI-RADS version 2 score of 3–5 yielded a sensitivity of 97.4%, a specificity of 50.9%, and an AUC of 0.74 in predicting CSPC. 15 However, it is difficult to perform multiparametric magnetic resonance imaging (MRI) in elderly patients with high PSA, and it may also be challenging because this imaging modality can only be performed at general hospitals.…”

Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center

“…Several factors should be considered prior to treatment. mpMRI has emerged as a key tool to localize cancer (15)(16)(17). In this manuscript we present our series of patients treated with PGA.…”