Abstract
Objective
To investigate whether presence of multifocality on multi-parametric magnetic resonance
imaging would increase the likelihood of detecting clinically-significant prostate
cancer in a PI-RADS 4 lesion.
Methods
We identified patients with at least 1 PI-RADS 4 lesion who underwent multi-parametric
magnetic resonance imaging-ultrasound fusion prostate biopsy. Patients were grouped
into 1 of 4 cohorts–cohort 1 (a PI-RADS 4 index lesion and an additional PI-RADS 2
or 3 lesion), cohort 2 (single lesion with PI-RADS 4), cohort 3 (2 or more PI-RADS
4 lesions), or cohort 4 (a PI-RADS 4 lesion and an index lesion with PI-RADS 5). We
compared the rate of grade group (GG) ≥ 2 pathology on targeted biopsy of PI-RADS
4 lesions between cohorts and evaluated clinical and radiological factors associated
with cancer detection.
Results
The overall rate of GG ≥ 2 pathology in the PI-RADS 4 lesions was 35.2%. The rate
of GG ≥ 2 pathology in the cohorts 1, 2, 3, and 4 was 21.7%, 36.3%, 49.1%, and 42.7%,
respectively (P< .001). On multivariable analysis, age (OR1.06, P < .001), clinical stage T2 (OR1.59, P= .03), prostate-specific antigen density (OR1.43, P < .001), peripheral zone lesion (OR1.62, P = .04), and study cohort (cohort 2 vs 1, OR1.93, P = .006; and cohort 3 vs 1, OR3.28, P < .001) were significantly associated with the risk of GG ≥ 2 in the PI-RADS 4 lesion.
Conclusion
On targeted biopsy of the PI-RADS 4 lesions, the proportion of GG ≥ 2 pathology is
approximately 35%. Rate of GG ≥ 2 detection in PI-RADS 4 lesions might differ based
on their location, multifocality, and PI-RADS classifications of other lesions identified.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prostate Imaging-Reporting and Data System Steering Committee: PI-RADS v2 status update and future directions.Eur Urol. 2019; 75: 385-396
- Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer.JAMA. 2015; 313: 390-397
- Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study.Lancet. 2017; 389: 815-822
- MRI-Targeted or standard biopsy for prostate-cancer diagnosis.N Engl J Med. 2018; 378: 1767-1777
- PI-RADS prostate imaging - reporting and data system: 2015, version 2.Eur Urol. 2016; 69: 16-40
- Prospective evaluation of PI-RADS version 2 using the international society of urological pathology prostate cancer grade group system.J Urol. 2017; 198: 583-590
- Proposed adjustments to PI-RADS version 2 decision rules: impact on prostate cancer detection.Radiology. 2017; 283: 119-129
- Peripheral zone lesions of intermediary risk in multiparametric prostate MRI: frequency and validation of the PI-RADSv2 risk stratification algorithm based on focal contrast enhancement.Eur J Radiol. 2018; 99: 62-67
- Characteristics of PI-RADS 4 lesions within the prostatic peripheral zone: a retrospective diagnostic accuracy study evaluating 170 lesions.Abdom Radiol. 2018; 43: 2176-2182
- Analysis of PI-RADS 4 cases: management recommendations for negatively biopsied patients.Eur J Radiol. 2019; 113: 1-6
- Detection of individual prostate cancer foci via multiparametric magnetic resonance imaging.Eur Urol. 2019; 75: 712-720
- Multifocality and prostate cancer detection by multiparametric magnetic resonance imaging: correlation with whole-mount histopathology.Eur Urol. 2015; 67: 569-576
- MR-guided biopsy and focal therapy: new options for prostate cancer management.Curr Opin Urol. 2018; 28: 93-101
- Establishing the distribution of satellite lesions in intermediate- and high-risk prostate cancer: implications for focused radiotherapy.Prostate Cancer Prostatic Dis. 2017; 20: 241-248
- Results of targeted biopsy in men with magnetic resonance imaging lesions classified equivocal, likely or highly likely to be clinically significant prostate cancer.Eur Urol. 2017; (pii: S0302-2838(17)30110-0)
- Frequent clonal relations between metastases and non-index prostate cancer lesions.JCI Insight. 2019; 4 (pii: 124756)
- The 2014 International Society of Urological Pathology (ISUP) consensus conference on gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system.Am J Surg Pathol. 2016; 40: 244-252
- Validation of the dominant sequence paradigm and role of dynamic contrast-enhanced imaging in PI-RADS Version 2.Radiology. 2017; 285: 859-869
- Prostate zonal anatomy correlates with the detection of prostate cancer on multiparametric magnetic resonance imaging/ultrasound fusion-targeted biopsy in patients with a solitary PI-RADS v2-scored lesion.Urol Oncol. 2017; 35 (542 e519-542 e524)
- Which scores need a core? An evaluation of MR-targeted biopsy yield by PIRADS score across different biopsy indications.Prostate Cancer Prostatic Dis. 2018; 21: 573-578
- Histologic findings associated with false-positive multiparametric magnetic resonance imaging performed for prostate cancer detection.Hum Pathol. 2019; 83: 159-165
- Prospective evaluation of the prostate imaging reporting and data system version 2 for prostate cancer detection.J Urol. 2016; 196: 690-696
- Risk of clinically significant prostate cancer associated with prostate imaging reporting and data system category 3 (equivocal) lesions identified on multiparametric prostate MRI.AJR Am J Roentgenol. 2018; 210: 347-357
- MRI-ultrasound fusion targeted biopsy of prostate imaging reporting and data system version 2 category 5 lesions found false-positive at multiparametric prostate MRI.AJR Am J Roentgenol. 2018; 210: W218-W225
- Dynamic contrast enhanced magnetic resonance imaging improves classification of prostate lesions: a study of pathological outcomes on targeted prostate biopsy.J Urol. 2017; 198: 1301-1308
- Targets missed: predictors of MRI-targeted biopsy failing to accurately localize prostate cancer found on systematic biopsy.Prostate Cancer Prostatic Dis. 2018; 21: 549-555
- Interobserver reproducibility of the PI-RADS version 2 lexicon: a multicenter study of six experienced prostate radiologists.Radiology. 2016; 280: 793-804
- Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2.Eur Urol. 2019; 76: 340-351
- Current status of magnetic resonance imaging (MRI) and ultrasonography fusion software platforms for guidance of prostate biopsies.BJU Int. 2014; 114: 641-652
- Elastic versus rigid image registration in magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy: a systematic review and meta-analysis.Eur Urol Focus. 2018; 4: 219-227
Article info
Publication history
Published online: August 13, 2019
Accepted:
August 2,
2019
Received:
April 16,
2019
Footnotes
Financial Disclosures: This work was funded in part by a pilot grant from the Young Supporters Board of the UAB Comprehensive Cancer Center and a Junior Faculty Development Grant (ACS-IRG 001-53) and by Developmental funds from the UAB Comprehensive Cancer Center Support Grant (NCI P30 CA 013148) granted to Soroush Rais-Bahrami.
Conflicts of Interest: Soroush Rais-Bahrami serves as a consultant for Philips/InVivo Corp, Genomic Health Inc, and Blue Earth Diagnostics. Preston Sprenkle serves as a consultant for Boston Scientific and GenomeDx Biosciences.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
