Related Experiment Video
Updated: Feb 23, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Score 3 prostate lesions: a gray zone for PI-RADS v2
Michele Scialpi1, Eugenio Martorana2, Maria Cristina Aisa1
1Department of Surgical and Biomedical Sciences, Division of Radiology 2, Perugia University, S.Maria Della Misericordia Hospital, S. Andrea Delle Fratte, Perugia, Italy.
Abstract:
Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) does not offer a precise guidance on the clinical management (biopsy or not biopsy) for PI-RADS v2 score 3 lesions. Lesion volume calculated on biparametric MRI (bpMRI) [T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI)] by introducing a cut-off of 0.5 mL, allows to distinguish the lesions assigned by the multiparametric MRI (mpMRI) to the category PI-RADS v2 score 3 in two subgroups: a) Indolent or low risk lesions with volume <0.5 mL, and b) Significant or high risk lesions with volume ≥0.5 mL. For mpMRI lesions assigned to PI-RADS v2 score 3, we suggest the following management: 1) Subgroup a (low-risk lesion): Clinical surveillance (accurate evaluation of age and clinical informations, periodic monitoring of prostate specific antigen value and repeated bpMRI 1 year later); 2) Subgroup b (high-risk lesion): Targeted biopsy. The proposed management would reduce the use of unnecessary biopsies and increase the diagostic yield of significant prostate cancer of approximately 50% and 30% respectively. These approaches encourage the radiologist to adopt MRI lesion volume to improve PI-RADS v2 and to optimize the management of PI-RADS v2 score 3 lesions.
Insights
Prostate MRI lesion volume can refine PI-RADS v2 score 3 management. Lesions under 0.5 mL suggest surveillance, while larger ones warrant biopsy, improving cancer detection and reducing unnecessary procedures.
Area of Science:
- Radiology
- Urology
- Oncology
Background:
- Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) lacks clear guidelines for PI-RADS v2 score 3 lesions.
- Distinguishing between indolent and significant prostate cancer in PI-RADS v2 score 3 lesions is clinically challenging.
Purpose of the Study:
- To evaluate the utility of biparametric MRI (bpMRI) lesion volume in managing PI-RADS v2 score 3 prostate lesions.
- To propose a refined management strategy for PI-RADS v2 score 3 lesions based on lesion volume.
Main Methods:
- Calculation of lesion volume using biparametric MRI (bpMRI) including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI).
- Introduction of a 0.5 mL volume cut-off to stratify PI-RADS v2 score 3 lesions into low-risk (<0.5 mL) and high-risk (≥0.5 mL) subgroups.
- Proposed management: clinical surveillance for low-risk lesions and targeted biopsy for high-risk lesions.
Main Results:
- Lesion volume on bpMRI can effectively differentiate PI-RADS v2 score 3 lesions.
- Subgrouping allows for distinct management strategies, potentially reducing unnecessary biopsies by approximately 50%.
- The approach may increase the diagnostic yield for significant prostate cancer by approximately 30%.
Conclusions:
- Incorporating MRI lesion volume into PI-RADS v2 assessment can optimize the management of PI-RADS v2 score 3 lesions.
- This strategy aids radiologists in making more informed decisions, improving diagnostic accuracy and patient outcomes.
- Refined management of PI-RADS v2 score 3 lesions through volume assessment enhances clinical utility.
