Purpose: To evaluate the cancer detection rates for each category of Prostate Imaging-Reporting and Data System version 2.1 (PI-RADSv2.1) using multiparametric magnetic resonance imaging (mpMRI) and biparametric MRI (bpMRI) based on MRI/ultrasound (US)-fusion biopsy.
Materials And Methods: This prospective study included participants who underwent mpMRI or bpMRI with a PI-RADSv2.1 interpretation and subsequently received MRI/US-fusion biopsy between August 2022 and December 2023. The lesion-based detection rates of clinically significant prostate cancer (csPCa) in each PI-RADSv2.1 category and the correlation between PI-RADSv2.1 categories and International Society of Urological Pathology (ISUP) grade groups were analyzed. The diagnostic performance of PI-RADSv2.1 in predicting csPCa was evaluated, and diagnostic performance of mpMRI and bpMRI was compared using cut-offs, with PI-RADSv2.1 categories ≥ 3 or ≥ 4 defined as positive.
Results: A total of 247 lesions from 216 participants were included in this study. A total of 157 patients underwent mpMRI and the remaining 59 underwent bpMRI. The csPCa detection rates for each PI-RADSv2.1 category of mpMRI and bpMRI were as follows: category 1, 0% (0/11); 2, 13% (3/23); 3, 16% (5/31); 4, 60% (43/72); 5, 65% (26/40), in mpMRI; category 1, 0% (0/4); 2, 33% (1/3); 3, 25% (3/12); 4, 61% (19/31); 5, 75% (15/20) in bpMRI. PI-RADSv2.1 categories were significantly positively associated with csPCa detection rates in both mpMRI and bpMRI (p < 0.0001 and p = 0.00048, respectively). PI-RADSv2.1 categories correlated with ISUP grade groups for mpMRI and bpMRI (p < 0.0001 for both). There were no significant differences in the detection rates between mpMRI and bpMRI for PI-RADS v2.1 positive and negative lesions.
Conclusion: PI-RADSv2.1 using mpMRI and bpMRI could stratify the risk of csPCa, and the csPCa detection rate of bpMRI was compatible with that of mpMRI using cut-offs of PI-RADSv2.1 categories ≥ 3 or ≥ 4.
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