Role of PI-RADSv2 with multiparametric MRI in determining who needs active surveillance or definitive treatment according to PRIAS

Abstract

Purpose: To evaluate the role of Prostate Imaging Reporting and Data System v. 2 (PI-RADSv2) in triaging patients with prostate cancer according to Prostate Cancer Research International: Active Surveillance (PRIAS). Materials and Methods: Between January 2012 and December 2014, 456 patients with biopsy-proven cancer underwent multiparametric 3T magnetic resonance imaging (MRI) using T2-weighted, diffusion-weighted, and dynamic contrast-enhanced MRI sequences, and then radical prostatectomy. Two radiologists independently reviewed MR images using PI-RADSv2. For AS, PRIAS required clinical stage <0.2 ng/mL2, Gleason score (GS) ≤6, and the number of positive cores ≤2. For AS, PI-RADSv2 required an index lesion scored <4. Standard reference was prostatectomy, in which insignificant cancer was defined as a small (<0.5 cm3) organ-confined lesion with GS ≤6. Sensitivity and specificity for insignificant cancer were obtained with PRIAS, PI-RADSv2, and both. Results: The sensitivity and specificity with PRIAS were 82.9% (68/82) and 70.9% (265/374), respectively. PI-RADSv2 decreased the sensitivity to 61% (50/82) to 80.5% (66/82), but increased the specificity to 77.8% (291/374) to 90.8% (340/374). The combination of PRIAS and PI-RDASv2 increased significantly the specificity to 89.6% (335/374) to 92.8% (347/374) (P < 0.001). Conclusion: PRIAS using multiparametric MRI can identify a greater number of insignificant cancers than PI-RADSv2. However, PI-RADSv2 helps detect many significant cancers that are misdiagnosed as insignificant cancer with PRIAS. Level of Evidence: 3. Technical Efficacy: Stage 2. J. MAGN. RESON. IMAGING 2017;45:1753–1759.