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Current Urology Reports

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08-11-2023 | Prostate Cancer

Management Strategy for Prostate Imaging Reporting and Data System Category 3 Lesions

Authors: Zhen Kang, Daniel J. Margolis, Shaogang Wang, Qiubai Li, Jian Song, Liang Wang

Published in: Current Urology Reports | Issue 12/2023

Abstract

Purpose of Review

Prostate Imaging Reporting and Data System (PI-RADS) category 3 lesions present a clinical dilemma due to their uncertain nature, which complicates the development of a definitive management strategy. These lesions have an incidence rate of approximately 22–32%, with clinically significant prostate cancer (csPCa) accounting for about 10–30%. Therefore, a thorough evaluation is warranted.

Recent Findings

This review highlights the need for radiology peer review, including the confirmation of dynamic contrast-enhanced (DCE) compliance, as the initial step. Additional MRI models such as VERDICT or Tofts need to be verified. Current evidence shows that imaging and clinical indicators can be used for risk stratification of PI-RADS 3 lesions. For low-risk lesions, a safety net monitoring approach involving annual repeat MRI can be employed. In contrast, lesions deemed potentially risky based on prostate-specific antigen density (PSAD), 68 Ga-PSMA PET/CT, MPS, Proclarix, or AI/machine learning models should undergo biopsy. It is recommended to establish a multidisciplinary team that takes into account factors such as age, PSAD, prostate, and lesion size, as well as previous biopsy pathological findings.

Summary

Combining expert opinions, clinical-imaging indicators, and emerging methods will contribute to the development of management strategies for PI-RADS 3 lesions.

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Title: Management Strategy for Prostate Imaging Reporting and Data System Category 3 Lesions
Authors: Zhen Kang
Daniel J. Margolis
Shaogang Wang
Qiubai Li
Jian Song
Liang Wang
Publication date: 08-11-2023
Publisher: Springer US
Keywords: Prostate Cancer
Prostate Cancer
Published in: Current Urology Reports / Issue 12/2023
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI: https://doi.org/10.1007/s11934-023-01187-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Management Strategy for Prostate Imaging Reporting and Data System Category 3 Lesions

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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