AI Article Synopsis
- MRI/ultrasound fusion-guided targeted biopsy (TBx) is essential for effective management of prostate cancer by helping with precise risk stratification.
- This study compared the performance of two versions of the PI-RADS scoring system (v2.0 and v2.1) in predicting changes in cancer severity after TBx and subsequent radical prostatectomy (RP).
- Results showed no significant differences in upgrade or downgrade rates between the two versions, indicating that both versions are equivalent in assessing clinically significant prostate cancer.
Article Abstract
Precise risk stratification through MRI/ultrasound (US) fusion-guided targeted biopsy (TBx) can guide optimal prostate cancer (PCa) management. The purpose of this study was to compare PI-RADS version 2.0 (v2.0) and PI-RADS version 2.1 (v2.1) in terms of the rates of International Society of Urological Pathology (ISUP) grade group (GG) upgrade and downgrade from TBx to radical prostatectomy (RP). This study entailed a retrospective post hoc analysis of patients who underwent 3-T prostate MRI at a single institution from May 2015 to March 2023 as part of three prospective clinical trials. Trial participants who underwent MRI followed by MRI/US fusion-guided TBx and RP within a 1-year interval were identified. A single genitourinary radiologist performed clinical interpretations of the MRI examinations using PI-RADS v2.0 from May 2015 to March 2019 and PI-RADS v2.1 from April 2019 to March 2023. Upgrade and downgrade rates from TBx to RP were compared using chi-square tests. Clinically significant cancer was defined as ISUP GG2 or greater. The final analysis included 308 patients (median age, 65 years; median PSA density, 0.16 ng/mL). The v2.0 group ( = 177) and v2.1 group ( = 131) showed no significant difference in terms of upgrade rate (29% vs 22%, respectively; = .15), downgrade rate (19% vs 21%, = .76), clinically significant upgrade rate (14% vs 10%, = .27), or clinically significant downgrade rate (1% vs 1%, > .99). The upgrade rate and downgrade rate were also not significantly different between the v2.0 and v2.1 groups when stratifying by index lesion PI-RADS category or index lesion zone, as well as when assessed only in patients without a prior PCa diagnosis (all > .01). Among patients with GG2 or GG3 at RP ( = 121 for v2.0; = 103 for v2.1), the concordance rate between TBx and RP was not significantly different between the v2.0 and v2.1 groups (53% vs 57%, = .51). Upgrade and downgrade rates from TBx to RP were not significantly different between patients whose MRI examinations were clinically interpreted using v2.0 or v2.1. Implementation of the most recent PI-RADS update did not improve the incongruence in PCa grade assessment between TBx and surgery.
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| http://dx.doi.org/10.2214/AJR.23.29964 | DOI Listing |
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