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. 2019 Apr;14(2):262-270.
doi: 10.5114/wiitm.2019.83869. Epub 2019 Mar 26.

Prostate Imaging Reporting and Data System in prostate cancer staging and planning for radical prostatectomy

Mieszko Kozikowski  1 , Bartłomiej Zagożdżon  1 , Magdalena Gola  2 , Jakub Dobruch  1
Affiliations

Prostate Imaging Reporting and Data System in prostate cancer staging and planning for radical prostatectomy

Mieszko Kozikowski et al. Wideochir Inne Tech Maloinwazyjne. 2019 Apr.

Abstract

Introduction: The Prostate Imaging Reporting and Data System (PI-RADS) was mainly developed for the purposes of prostate cancer (PCa) detection. However, its widespread use suggests that it may play a role in a preoperative workup prior to endoscopic radical prostatectomy (ERP).

Aim: To evaluate the prognostic value of PI-RADS in predicting extraprostatic extension (EPE) and its influence on surgical planning of ERP.

Material and methods: The analysis involved data of 154 consecutive prostate cancer patients, in whom multiparametric 3.0T magnetic resonance imaging (mpMRI) was performed before ERP. Standard descriptive assessment of mpMRI images was compared with the PI-RADS system with respect to prostate cancer staging and subsequent potential surgical template adjustment.

Results: PI-RADS significantly outperformed the standard way of mpMRI reporting in staging (AUC = 0.615 vs. 0.552, p = 0.036) with PI-RADS 5 established as the best threshold. After reevaluation of imaging, the initial surgical plan was modified based on mpMRI in terms of feasibility and extent of neurovascular bundle preservation during ERP on 96 (31.2%) sides, while on the remaining 212 (68.8%) sides the templates were left unchanged. Decisions based on mpMRI were not associated with increased risk of a positive surgical margin (PSM).

Conclusions: The PI-RADS outperforms the standard staging method using mpMRI and may assist the decision-making process regarding the extent of resection during ERP without increasing the risk of PSM.

Keywords: decision-making; mini-invasive surgery; multiparametric magnetic resonance imaging; neurovascular bundle; prostate cancer; radical prostatectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of staging performance of mpMRI and PI-RADS using ROC PI-RADS is shown as the blue curve, mpMRI as the red curve.
Figure 2
Figure 2
Comparison of staging performance of models incorporating mpMRI or PI-RADS using ROC The model using PI-RADS is shown as the blue curve, the model using mpMRI as the red curve.
See this image and copyright information in PMC

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