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. 2017 Sep;198(3):583-590.
doi: 10.1016/j.juro.2017.03.131. Epub 2017 Mar 31.

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

Sherif Mehralivand  1 , Sandra Bednarova  2 , Joanna H Shih  3 , Francesca V Mertan  4 , Sonia Gaur  4 , Maria J Merino  5 , Bradford J Wood  6 , Peter A Pinto  7 , Peter L Choyke  4 , Baris Turkbey  8
Affiliations

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

Sherif Mehralivand et al. J Urol. 2017 Sep.

Abstract

Purpose: The PI-RADS™ (Prostate Imaging Reporting and Data System), version 2 scoring system, introduced in 2015, is based on expert consensus. In the same time frame ISUP (International Society of Urological Pathology) introduced a new pathological scoring system for prostate cancer. Our goal was to prospectively evaluate the cancer detection rates for each PI-RADS, version 2 category and compare them to ISUP group scores in patients undergoing systematic biopsy and magnetic resonance imaging-transrectal ultrasound fusion guided biopsy.

Materials and methods: A total of 339 treatment naïve patients prospectively underwent multiparametric magnetic resonance imaging evaluated with PI-RADS, version 2 with subsequent systematic and fusion guided biopsy from May 2015 to May 2016. ISUP scores were applied to pathological specimens. An ISUP score of 2 or greater (ie Gleason 3 + 4 or greater) was defined as clinically significant prostate cancer. Cancer detection rates were determined for each PI-RADS, version 2 category as well as for the T2 weighted PI-RADS, version 2 categories in the peripheral zone.

Results: The cancer detection rate for PI-RADS, version 2 categories 1, 2, 3, 4 and 5 was 25%, 20.2%, 24.8%, 39.1% and 86.9% for all prostate cancer, and 0%, 9.6%, 12%, 22.1% and 72.4% for clinically significant prostate cancer, respectively. On T2-weighted magnetic resonance imaging the cancer detection rate in the peripheral zone was significantly higher for PI-RADS, version 2 category 4 than for overall PI-RADS, version 2 category 4 in the peripheral zone (all prostate cancer 36.6% vs 48.1%, p = 0.001, and clinically significant prostate cancer 22.9% vs 32.6%, p = 0.002).

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

Keywords: biopsy; diagnostic imaging; early detection of cancer; prostatic neoplasms; reference standards.

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Figures

Figure 1.
Figure 1.
Study inclusion and exclusion criteria. Previous treatment included radical prostatectomy, external radiation therapy, brachytherapy, focal ablation, vaccine therapy, androgen deprivation and bladder instillation.
Figure 2.
Figure 2.
Distribution of ISUP scores and benign biopsies among PI-RADS categories. Percentage corresponds to proportion of ISUP scores compared to all cancer positive lesions detected for each category.
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