Re: Prostate Cancer Genomic Classifier Relates More Strongly to Gleason Grade Group than Prostate Imaging Reporting and Data System Score in Multiparametric Prostate Magnetic Resonance Imaging-Ultrasound Fusion Targeted Biopsies

Objective: Prostate cancer has a high prevalence and mortality, being the most diagnosed urologic cancer. Prostatic magnetic resonance imaging showed high sensitivity in the detection of clinically significant neoplasia and agreement with the Gleason score. Therefore, we attempted to evaluate the diagnostic accuracy of the prostate imaging reporting and data system, using biopsy and prostatectomy as the reference standard. The secondary goal of correlating prostatic magnetic resonance imaging findings and anatomopathological samples is obtained. Materials and Methods: We retrospectively analyzed seventy-nine 1.5 Tesla prostatic magnetic resonance imaging scans in patients aged 31 to 86 years, performed at the Clinical Hospital of the Federal University of Paraná between January 2015 and February 2018. Results: Considering all 79 patients, prostatic magnetic resonance imaging was able to diagnose tumor in 47 patients (59.4%). Considering the peripheral zone, the prostatic magnetic resonance imaging had a sensitivity of 75.0% (95% confidence interval: 52.1%–98.0%), specificity of 89.5% (95% confidence interval: 66.0%–100%), 94.4% positive predictive value (95% confidence interval: 71.0%–100%), 66.7% negative predictive value (95% confidence interval: 43.0%–69.0%), 83.8% Positive Likelihood Ratio (PVR) (95% confidence interval: 60.0%–100%), 27.9% Negative Likelihood Ratio (RVN) (95% confidence interval: 5.0%–50.0 %), and accuracy of 86.3% (95% confidence interval: 63.0%–100%). The receiver operating characteristic curve obtained demonstrated the sensitivity variation according to the prostate imaging reporting and data system score of the patients, obtaining an area under the curve of 84.8 for a prostate imaging reporting and data system cutoff of 3. Conclusion: The use of the prostate imaging reporting and data system score is useful for the screening and classification of prostate cancer, due to its easy reproducibility, even in a population with an unknown prostate cancer prevalence, which can be easily correlated with biopsy studies and/or radical prostatectomy.

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The Utility of Combined Target and Systematic Prostate Biopsies in the Diagnosis of Clinically Significant Prostate Cancer Using Prostate Imaging Reporting and Data System Version 2 Based on Biparametric Magnetic Resonance Imaging

Current Oncology ◽

10.3390/curroncol28020123 ◽

2021 ◽

Vol 28 (2) ◽

pp. 1294-1301

Author(s):

Daiki Kato ◽

Kaori Ozawa ◽

Shinichi Takeuchi ◽

Makoto Kawase ◽

Kota Kawase ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Data System ◽

Receiver Coil ◽

Resonance Imaging ◽

Prostate Imaging ◽

Rate Of Increase ◽

Clinically Significant

This study aimed to determine the predictive value of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) based on biparametric magnetic resonance imaging (bpMRI) with combined target biopsy (TBx) and systematic biopsy (SBx) in patients with suspicion of having clinically significant prostate cancer (csPCa). In this retrospective study, we reviewed the clinical and pathological records of 184 consecutive patients who underwent bpMRI before prostate biopsy. We focused on patients with PI-RADS v2 scores ≥ 3. MRI was performed using a 3-Tesla clinical scanner with a 32-channel phased-array receiver coil. PI-RADS v2 was used to describe bpMRI findings based on T2-weighted imaging and diffusion-weighted imaging scores. The primary endpoint was the diagnostic accuracy rate of PI-RADS v2 based on bpMRI for patients with prostate cancer (PCa) who underwent combined TBx and SBx. A total of 104 patients were enrolled in this study. Combined TBx and SBx was significantly superior to either method alone for PCa detection in patients with suspicious lesions according to PI-RADS v2. TBx and SBx detected concordant csPCa in only 24.1% of the patients. In addition, the rate of increase in the Gleason score was similar between SBx (41.5%) and TBx (34.1%). The diagnostic accuracy of bpMRI is comparable to that of standard multiparametric MRI for the detection of csPCa. Moreover, combined TBx and SBx may be optimal for the accurate determination of csPCa diagnosis, the International Society of Urological Pathology grade, and risk classification.

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