Positive Predictive Value of Prostate Imaging Reporting and Data System Version 2 for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis

Mazzone, Elio; Stabile, Armando; Pellegrino, Francesco; Basile, Giuseppe; Cignoli, Daniele; Cirulli, Giuseppe; Sorce, Gabriele; Barletta, Francesco; Scuderi, Simone; Bravi, Carlo Andrea; Cucchiara, Vito; Fossati, Nicola; Gandaglia, Giorgio; Montorsi, Francesco; Briganti, Alberto

doi:10.1016/j.euo.2020.12.004

Cited by 114 publications

(104 citation statements)

References 80 publications

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“…PI-RADS plays an essential role in detecting csPCa using mpMRI in order to select appropriate candidates for PB (17). Pooled meta-analyses with random-effect models showed that the positive predictive value for csPCa was 8% with PI-RADS 2, 13% with PI-RADS 3, 40% with PI-RADS 4, and 69% with PI-RADS 5 (34). Han et al reported that the PCDR is 0% in patients with PI-RADS 1 and 4.6% in those with PI-RADS 2 (35).…”

Section: Discussionmentioning

confidence: 99%

The accuracy of prostate cancer diagnosis in biopsy-naive patients using combined magnetic resonance imaging and transrectal ultrasound fusion-targeted prostate biopsy

Uno¹,

Taniguchi²,

Seike³

et al. 2021

Transl Androl Urol

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Background: This study aimed to estimate whether multiparametric magnetic resonance imaging (mpMRI)-transrectal ultrasound (TRUS) fusion biopsy (FUS-TB) increases the detection rates of clinically significant prostate cancer (csPCa) compared with TRUS-guided systematic biopsy (TRUS-GB).Methods: This retrospective study focused on patients who underwent mpMRI before prostate biopsy (PB) with Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) scores ≥3 and prostate-specific antigen (PSA) level between 2.5 and 20 ng/mL. Before FUS-TB, the biopsy needle position was checked virtually using three-dimensional mapping. After confirming the position of the target within the prostate, biopsy needle was inserted and PB was performed. Suspicious lesions were generally targeted with 2 to 4 cores. Subsequently, 10-12 cores were biopsied for TRUS-GB. The primary endpoint was the PCa detection rate (PCDR) for patients with PCa who underwent combined FUS-TB and TRUS-GB.Results: According to PI-RADS v2, 76.7% of the patients with PI-RADS v2 score ≥3 were diagnosed with PCa. The PCDRs in patients with PI-RADS v2 score of 4 or 5 were significantly higher than those in patients with PI-RADS v2 score of 3 (3 vs. 4, P<0.001; 3 vs. 5, P<0.001; 4 vs. 5, P=0.073). According to PCDR, the detection rates of PCa and csPCa in the FUS-TB were significantly higher than that in the TRUS-GB.Conclusions: Following detection of suspicious tumor lesions on mpMRI, FUS-TB use detects a higher number of PCa cases compared with TRUS-GB.

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Section: Discussionmentioning

confidence: 99%

The accuracy of prostate cancer diagnosis in biopsy-naive patients using combined magnetic resonance imaging and transrectal ultrasound fusion-targeted prostate biopsy

Uno¹,

Taniguchi²,

Seike³

et al. 2021

Transl Androl Urol

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“…The current decision-making with prostate biopsies is based on the Prostate Imaging-Report and Data System (PI-RADS) [ 6 ], and clinicians usually avoid prostate biopsies when the PI-RADS score is <3 due to the high negative predictive value of mpMRI for csPCa, reaching up to 95% [ 4 ]. In contrast, prostate biopsies are always recommended in men with PI-RADS > 3, due to the risk of csPCa higher than 50% in men with PI-RADS 4 and around 90% in those with PI-RADS 5 [ 7 ]. Finally, PI-RADS 3 is an uncertain scenario in which the likelihood of csPCa does not reach 20% and the over-detection of iPCa exceeds 50% of tumours detected [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Multiparametric Magnetic Resonance Imaging Grades the Aggressiveness of Prostate Cancer

Morote

Borque‐Fernando

Triquell

et al. 2022

Cancers

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We sought to find further evidence showing the increase in PCa aggressiveness as PI-RADS score increases from four surrogates of PCa aggressiveness: i. prostate biopsy GG (≤3 vs. >3), ii. type of pathology in surgical specimens (favourable vs. unfavourable), iii. clinical stage (localised vs. advanced), and risk of recurrence of localised PCa after primary treatment (low-intermediate vs. high). A group of 692 PCa patients were diagnosed after 3-T multiparametric MRI (mpMRI) and guided and/or systematic biopsies, showing csPCa (GG ≥ 2) in 547 patients (79%) and insignificant PCa (iPCa) in 145 (21%). The csPCa rate increased from 32.4% in PI-RADS < 3 to 95.5% in PI-RADS 5 (p < 0.001). GG ≥ 3 was observed in 7.6% of PCa with PI-RADS < 3 and 32.6% in those with PI-RADS > 3 (p < 0.001). Unfavourable pathology was observed in 38.9% of PCa with PI-RAD < 3 and 68.3% in those with PI-RADS > 3 (p = 0.030). Advanced disease was not observed in PCa with PI-RADS ≤ 3, while it existed in 12.7% of those with PI-RADS > 3 (p < 0.001). High-risk recurrence localised PCa was observed in 9.5% of PCa with PI-RADS < 3 and 35% in those with PI-RADS > 3 (p = 0.001). The PI-RADS score was an independent predictor of all surrogates of PCa aggressiveness as PSA density. We confirmed that mpMRI grades PCa aggressiveness.

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“…Clinical guidance using the PI-RADS v2 system is limited when considering lesions of score 3, which are noted to be equivocal for clinically significant prostate cancer. While the positive predictive value of clinically significant prostate cancer is often quite low for PI-RADS 3 lesions-just 13% based on a recent meta-analysis [7]-inter-reader reliability remains a concern [8]. There is significant variability between reported prevalence and clinically significant prostate cancer detection among studies in the existing literature [9].…”

Section: Introductionmentioning

confidence: 99%

Considering Predictive Factors in the Diagnosis of Clinically Significant Prostate Cancer in Patients with PI-RADS 3 Lesions

Natale

Koller

Greenberg

et al. 2021

Life

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The use of multi-parametric magnetic resonance imaging (mpMRI) in conjunction with the Prostate Imaging Reporting and Data System (PI-RADS) is standard practice in the diagnosis, surveillance, and staging of prostate cancer. The risk associated with lesions graded at a PI-RADS score of 3 is ambiguous. Further characterization of the risk associated with PI-RADS 3 lesions would be useful in guiding further work-up and intervention. This study aims to better characterize the utility of PI-RADS 3 and associated risk factors in detecting clinically significant prostate cancer. From a prospectively maintained IRB-approved dataset of all veterans undergoing mpMRI fusion biopsy at the Southeastern Louisiana Veterans Healthcare System, we identified a cohort of 230 PI-RADS 3 lesions from a dataset of 283 consecutive UroNav-guided biopsies in 263 patients from October 2017 to July 2020. Clinically significant prostate cancer (Gleason Grade ≥ 2) was detected in 18 of the biopsied PI-RADS 3 lesions, representing 7.8% of the overall sample. Based on binomial analysis, PSA densities of 0.15 or greater were predictive of clinically significant disease, as was PSA. The location of the lesion within the prostate was not shown to be a statistically significant predictor of prostate cancer overall (p = 0.87), or of clinically significant disease (p = 0.16). The majority of PI-RADS 3 lesions do not represent clinically significant disease; therefore, it is possible to reduce morbidity through biopsy. PSA density is a potential adjunctive factor in deciding which patients with PI-RADS 3 lesions require biopsy. Furthermore, while the risk of prostate cancer for African-American men has been debated in the literature, our findings indicate that race is not predictive of identifying prostate cancer, with comparable Gleason grade distributions on histology between races.

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Positive Predictive Value of Prostate Imaging Reporting and Data System Version 2 for the Detection of Clinically Significant Prostate Cancer: A Systematic Review and Meta-analysis

Cited by 114 publications

References 80 publications

The accuracy of prostate cancer diagnosis in biopsy-naive patients using combined magnetic resonance imaging and transrectal ultrasound fusion-targeted prostate biopsy

The accuracy of prostate cancer diagnosis in biopsy-naive patients using combined magnetic resonance imaging and transrectal ultrasound fusion-targeted prostate biopsy

Multiparametric Magnetic Resonance Imaging Grades the Aggressiveness of Prostate Cancer

Considering Predictive Factors in the Diagnosis of Clinically Significant Prostate Cancer in Patients with PI-RADS 3 Lesions

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