Prostagram magnetic resonance imaging in a screening population: Prostate Imaging-Reporting and Data System or...

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Prostate cancer screening aims to detect malignancies early.
• Accurate interpretation of MRI scans is crucial for guiding biopsy decisions.
• The Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) and Likert scale are used for reporting prostate MRI findings.

Purpose of the Study:

• To compare the biopsy recommendation rates and diagnostic accuracy of PI-RADSv2 and the Likert scale for detecting clinically significant prostate cancer.
• To evaluate the performance of these scoring systems in a prostate cancer screening population.

Main Methods:

• 406 men aged 50-69 years underwent non-contrast-enhanced Prostagram MRI as part of a screening trial.
• Scans were reported using PI-RADSv2 (excluding dynamic contrast-enhanced sequence score) and a 5-point Likert scale.
• Biopsies were recommended for scores ≥3; detection rates for Grade Groups (GGs) 1 and ≥2 were compared.
• Receiver operating characteristic (ROC) analysis was used to assess accuracy.

Main Results:

• More patients were recommended for biopsy using the Likert scale (23%) compared to PI-RADSv2 (18%) at a score threshold of ≥3 (P=0.03).
• At a score threshold of ≥4, biopsy recommendations were similar (Likert 9% vs. PI-RADSv2 11%; P=0.40).
• Detection rates for significant cancer (GG ≥2) and insignificant cancer (GG1) were comparable between the two systems (P>0.50).
• The accuracy (area under ROC curve) was similar for both PI-RADSv2 (0.64) and Likert scale (0.65) (P=0.95).

Conclusions:

• PI-RADSv2 and the Likert scale demonstrate similar accuracy for non-contrast-enhanced Prostagram MRI in prostate cancer screening.
• The Likert scale resulted in a higher proportion of men being recommended for biopsy without a corresponding increase in significant cancer detection.
• Development of an improved scoring system, potentially a modified Likert or standalone system, is warranted for enhanced Prostagram MRI reporting.