PI-RADS in Predicting csPCa: A Comparison Between Academic and Nonacademic Centers

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Multiparametric magnetic resonance imaging (mpMRI) has transformed prostate cancer (PCa) diagnosis, improving localization of clinically significant PCa (csPCa) and guiding biopsies.
• Variability exists in mpMRI execution, interpretation, and reporting across institutions, highlighting a need for standardization.
• This study evaluates the diagnostic performance of mpMRI from academic versus nonacademic centers in detecting csPCa.

Purpose of the Study:

• To compare the diagnostic efficacy of mpMRI in detecting csPCa between academic and nonacademic centers.
• To identify factors associated with csPCa detection in patients undergoing MRI/US fusion biopsies.

Main Methods:

• Prospective study of 810 men with elevated PSA and/or abnormal DRE undergoing MRI/US fusion biopsy.
• Patients with PI-RADS ≥ 3 lesions were divided into academic (n=354) and nonacademic (n=456) mpMRI groups.
• Clinical, mpMRI, and pathological data were collected and analyzed using R software.

Main Results:

• Academic centers showed higher rates of PI-RADS > 3 scores (72.6% vs. 62.3%, p=0.003).
• No significant differences in ISUP grade distribution were found between groups.
• Increased age, PSA, DRE positivity, and higher PSA density were associated with csPCa detection; academic centers had higher csPCa detection odds for PI-RADS > 3.

Conclusions:

• Significant variability in PI-RADS score assignment exists between academic and nonacademic centers, impacting csPCa detection.
• This variability necessitates improved standardization of PI-RADS scoring to enhance diagnostic consistency and reduce disparities.