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World Journal of Urology

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Open Access 01-12-2024 | Prostate Cancer | Topic Paper

PI-RADS upgrading as the strongest predictor for the presence of clinically significant prostate cancer in patients with initial PI-RADS-3 lesions

Authors: Jeremy Kwe, Martin Baunacke, Katharina Boehm, Ivan Platzek, Christian Thomas, Angelika Borkowetz

Published in: World Journal of Urology | Issue 1/2024

Abstract

Purpose

Unclear lesions on multiparametric magnetic resonance tomography (mpMRI) are challenging for the indication of biopsy in patients with clinical suspicion of prostate cancer (PCa). The aim of this study is the validation of the detection rate of clinically significant PCa (csPCa) in patients with PI-RADS 3 findings and to determine the appropriate follow-up strategy.

Methods

In this retrospective single-center study, patients with maximum PI-RADS 3 lesions underwent targeted MRI/ultrasound-fusion biopsy (tPbx) combined with systematic 12-core biopsy (sPbx) and follow-up mpMRI with further control biopsy. We assessed the evolution of MRI findings (PI-RADS, volume of the lesion), clinical parameters and histopathology in follow-up MRI and biopsies. The primary objective is the detection rate of csPCa, defined as ISUP ≥ 2 findings.

Results

A total of 126 patients (median PSA 6.65 ng/ml; median PSA-density (PSAD) 0.13 ng/ml²) were included. The initial biopsy identified low-risk PCa in 24 cases (19%). During follow-up biopsy, 22.2% of patients showed PI-RADS upgrading (PI-RADS > 3), and 29 patients (23%) exhibited a tumor upgrading. Patients with PI-RADS upgrading had a higher risk of csPCa compared to those without PI-RADS upgrading (42.9% vs. 9.18%, p < 0.05). PI-RADS upgrading was identified as an independent predictor for csPCa in follow-up biopsy (OR 16.20; 95% CI 1.17–224.60; p = 0.038).

Conclusion

Patients with stable PI-RADS 3 findings may not require a follow-up biopsy. Instead, it is advisable to schedule an MRI, considering that PI-RADS upgrading serves as an independent predictor for csPCa.

Barentsz JO, Weinreb JC, Verma S et al (2016) Synopsis of the PI-RADS v2 guidelines for multiparametric prostate magnetic resonance imaging and recommendations for use. Eur Urol 69:41–49. https://doi.org/10.1016/j.eururo.2015.08.038CrossRefPubMed

Maggi M, Panebianco V, Mosca A et al (2020) Prostate imaging reporting and data system 3 category cases at multiparametric magnetic resonance for prostate cancer: a systematic review and meta-analysis. Eur Urol Focus 6:463–478. https://doi.org/10.1016/j.euf.2019.06.014CrossRefPubMed

Mottet N, Van Den Bergh RCN, Briers E et al (2021) EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 79:243–262. https://doi.org/10.1016/j.eururo.2020.09.042CrossRefPubMed

Deutschland, Deutschland, Bundesärztekammer, Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (2016) S3-Leitlinie Methamphetamin-bezogene Störungen. Springer, Berlin

Liddell H, Jyoti R, Haxhimolla HZ (2015) mp-MRI prostate characterised PIRADS 3 lesions are associated with a low risk of clinically significant prostate cancer—a retrospective review of 92 biopsied PIRADS 3 lesions. Curr Urol 8:96–100. https://doi.org/10.1159/000365697CrossRefPubMedPubMedCentral

Bastian-Jordan M (2018) Magnetic resonance imaging of the prostate and targeted biopsy, comparison of PIRADS and Gleason grading. J Med Imaging Radiat Oncol 62:183–187. https://doi.org/10.1111/1754-9485.12678CrossRefPubMed

Scialpi M, Martorana E, Aisa MC et al (2017) Score 3 prostate lesions: a gray zone for PI-RADS v2. Turk J Urol 43:237–240. https://doi.org/10.5152/tud.2017.01058CrossRefPubMedPubMedCentral

Washino S, Okochi T, Saito K et al (2017) Combination of prostate imaging reporting and data system (PI-RADS) score and prostate-specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naïve patients. BJU Int 119:225–233. https://doi.org/10.1111/bju.13465CrossRefPubMed

Steinkohl F, Gruber L, Bektic J et al (2018) Retrospective analysis of the development of PIRADS 3 lesions over time: when is a follow-up MRI reasonable? World J Urol 36:367–373. https://doi.org/10.1007/s00345-017-2135-0CrossRefPubMed

10.

Thompson J, Lawrentschuk N, Frydenberg M et al (2013) The role of magnetic resonance imaging in the diagnosis and management of prostate cancer: The role of magnetic resonance imaging in the diagnosis and management of prostate cancer. BJU Int 112:6–20. https://doi.org/10.1111/bju.12381CrossRefPubMed

11.

Distler FA, Radtke JP, Bonekamp D et al (2017) The value of PSA density in combination with PI-RADS™ for the accuracy of prostate cancer prediction. J Urol 198:575–582. https://doi.org/10.1016/j.juro.2017.03.130CrossRefPubMed

12.

Schoots IG, Padhani AR (2021) Risk-adapted biopsy decision based on prostate magnetic resonance imaging and prostate-specific antigen density for enhanced biopsy avoidance in first prostate cancer diagnostic evaluation. BJU Int 127:175–178. https://doi.org/10.1111/bju.15277CrossRefPubMed

13.

Oerther B, Engel H, Bamberg F et al (2022) Cancer detection rates of the PI-RADSv2.1 assessment categories: systematic review and meta-analysis on lesion level and patient level. Prostate Cancer Prostatic Dis 25:256–263. https://doi.org/10.1038/s41391-021-00417-1CrossRefPubMed

14.

Schoots IG, Roobol MJ (2020) Multivariate risk prediction tools including MRI for individualized biopsy decision in prostate cancer diagnosis: current status and future directions. World J Urol 38:517–529. https://doi.org/10.1007/s00345-019-02707-9CrossRefPubMed

15.

Grönberg H, Eklund M, Picker W et al (2018) Prostate cancer diagnostics using a combination of the Stockholm3 blood test and multiparametric magnetic resonance imaging. Eur Urol 74:722–728. https://doi.org/10.1016/j.eururo.2018.06.022CrossRefPubMed

16.

Steyerberg EW, Roobol MJ, Kattan MW et al (2007) Prediction of indolent prostate cancer: validation and updating of a prognostic nomogram. J Urol 177:107–112. https://doi.org/10.1016/j.juro.2006.08.068CrossRefPubMed

17.

Schlenker B, Apfelbeck M, Armbruster M et al (2019) Comparison of PIRADS 3 lesions with histopathological findings after MRI-fusion targeted biopsy of the prostate in a real world-setting. CH 71:165–170. https://doi.org/10.3233/CH-189407CrossRef

18.

Sathianathen NJ, Konety BR, Soubra A et al (2018) Which scores need a core? An evaluation of MR-targeted biopsy yield by PIRADS score across different biopsy indications. Prostate Cancer Prostatic Dis 21:573–578. https://doi.org/10.1038/s41391-018-0065-6CrossRefPubMed

19.

Wadera A, Alabousi M, Pozdnyakov A et al (2021) Impact of PI-RADS Category 3 lesions on the diagnostic accuracy of MRI for detecting prostate cancer and the prevalence of prostate cancer within each PI-RADS category: a systematic review and meta-analysis. BJR 94:20191050. https://doi.org/10.1259/bjr.20191050CrossRefPubMed

20.

Boschheidgen M, Schimmöller L, Doerfler S et al (2022) Single center analysis of an advisable control interval for follow-up of patients with PI-RADS category 3 in multiparametric MRI of the prostate. Sci Rep 12:6746. https://doi.org/10.1038/s41598-022-10859-9CrossRefPubMedPubMedCentral

21.

Yilmaz EC, Shih JH, Belue MJ et al (2023) Prospective evaluation of PI-RADS version 2.1 for prostate cancer detection and investigation of multiparametric MRI–derived markers. Radiology 307:e221309. https://doi.org/10.1148/radiol.221309CrossRefPubMed

22.

Filson CP, Natarajan S, Margolis DJA et al (2016) Prostate cancer detection with magnetic resonance-ultrasound fusion biopsy: the role of systematic and targeted biopsies: CaP Detection With MR-US Fusion Biopsy. Cancer 122:884–892. https://doi.org/10.1002/cncr.29874CrossRefPubMed

23.

Schoots IG (2018) MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions? Transl Androl Urol 7:70–82. https://doi.org/10.21037/tau.2017.12.31CrossRefPubMedPubMedCentral

24.

Ullrich T, Quentin M, Arsov C et al (2018) Risk stratification of equivocal lesions on multiparametric magnetic resonance imaging of the prostate. J Urol 199:691–698. https://doi.org/10.1016/j.juro.2017.09.074CrossRefPubMed

25.

Recabal P, Assel M, Sjoberg DD et al (2016) the efficacy of multiparametric magnetic resonance imaging and magnetic resonance imaging targeted biopsy in risk classification for patients with prostate cancer on active surveillance. J Urol 196:374–381. https://doi.org/10.1016/j.juro.2016.02.084CrossRefPubMedPubMedCentral

26.

Rosenkrantz AB, Verma S, Choyke P et al (2016) Prostate magnetic resonance imaging and magnetic resonance imaging targeted biopsy in patients with a prior negative biopsy: a consensus statement by AUA and SAR. J Urol 196:1613–1618. https://doi.org/10.1016/j.juro.2016.06.079CrossRefPubMedPubMedCentral

27.

Omri N, Kamil M, Alexander K et al (2020) Association between PSA density and pathologically significant prostate cancer: the impact of prostate volume. Prostate 80:1444–1449. https://doi.org/10.1002/pros.24078CrossRefPubMed

28.

Nordström T, Akre O, Aly M et al (2018) Prostate-specific antigen (PSA) density in the diagnostic algorithm of prostate cancer. Prostate Cancer Prostatic Dis 21:57–63. https://doi.org/10.1038/s41391-017-0024-7CrossRefPubMed

29.

Boesen L, Nørgaard N, Løgager V et al (2019) Prebiopsy biparametric magnetic resonance imaging combined with prostate-specific antigen density in detecting and ruling out gleason 7–10 prostate cancer in Biopsy-naïve Men. European Urology Oncology 2:311–319. https://doi.org/10.1016/j.euo.2018.09.001CrossRefPubMed

30.

Oishi M, Shin T, Ohe C et al (2019) Which PATIENTS WITH NEGATIVE MAGNETIC RESONANCE IMAGING CAN SAFELY AVOID BIOPSY FOR PROSTATE CANCER? J Urol 201:268–277. https://doi.org/10.1016/j.juro.2018.08.046CrossRefPubMedPubMedCentral

Title: PI-RADS upgrading as the strongest predictor for the presence of clinically significant prostate cancer in patients with initial PI-RADS-3 lesions
Authors: Jeremy Kwe
Martin Baunacke
Katharina Boehm
Ivan Platzek
Christian Thomas
Angelika Borkowetz
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Published in: World Journal of Urology / Issue 1/2024
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-024-04776-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

PI-RADS upgrading as the strongest predictor for the presence of clinically significant prostate cancer in patients with initial PI-RADS-3 lesions

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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