Related Experiment Video
Updated: May 9, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Variation in Prostate Magnetic Resonance Imaging Performance: Data from the Prostate Biopsy Collaborative Group
Sunny B Nalavenkata1, Emily Vertosick2, Alberto Briganti3
1Department of Surgery (Urology Service), Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Westmead Hospital, The University of Sydney, Sydney, Australia.
Background And Objective:
The quality and reporting of prostate magnetic resonance imaging (MRI) are operator dependent, leading to variations in estimates such as positive predictive value across sites. This impacts patient counseling, risk modeling, and risk calculators. This study assessed variation in Prostate Imaging Reporting and Data System (PI-RADS) score classification and subsequent probability of grade group (GG) ≥2 + prostate cancer.
Methods:
Data from the Prostate Biopsy Collaborative Group, including multiple sites in North America, Europe, and Asia Pacific, were analyzed. Patients underwent multiparametric MRI (mpMRI) of the prostate followed by prostate biopsy during the years 2010-2023. Only those with MRI-targeted biopsy and PI-RADS score ≥3 were included. The risk of being assigned PI-RADS 4 or 5 and risk of GG ≥2 disease for these scores were estimated using logistic regression.
Key Findings And Limitations:
The cohort included 7325 biopsies from 7320 unique patients from 13 sites. A two-fold variation in the probability of PI-RADS 4 or 5 assignment across sites persisted even after adjustment for patient risk (heterogeneity p < 0.001 for both). There were significant differences in the absolute risk of GG ≥2 disease for PI-RADS 4 and 5 (heterogeneity p < 0.001 for both), varying between 23% and 68% and between 49% and 87%, respectively. The use of prostate biopsy as a reference standard has limitations but reflects typical usage of mpMRI in clinical practice.
Conclusions And Clinical Implications:
The probability of being assigned PI-RADS 4 or 5 and subsequent detection of GG ≥2 disease varies widely between institutions. This impacts counseling, risk stratification, and clinical practice, necessitating better standardization in the performance and interpretation of mpMRI.
Insights
Prostate MRI quality varies by institution, affecting cancer risk assessment. This variability impacts patient counseling and risk calculators, highlighting the need for standardized multiparametric MRI protocols.
Area of Science:
- Radiology
- Urologic Oncology
- Medical Imaging Analysis
Background:
- Prostate magnetic resonance imaging (MRI) quality and reporting are operator-dependent, causing variations in diagnostic accuracy.
- These variations affect the positive predictive value of imaging across different healthcare sites.
- Inconsistent results impact crucial aspects of patient care, including counseling, risk modeling, and the reliability of risk calculators.
Purpose of the Study:
- To assess the variation in Prostate Imaging Reporting and Data System (PI-RADS) score classification across multiple institutions.
- To evaluate the subsequent probability of detecting grade group (GG) ≥2 prostate cancer based on PI-RADS scores.
- To identify the impact of inter-institutional variability on clinical decision-making for prostate cancer.
Main Methods:
- Analysis of data from the Prostate Biopsy Collaborative Group, encompassing 13 sites across North America, Europe, and Asia Pacific (2010-2023).
- Inclusion of patients who underwent multiparametric MRI (mpMRI) followed by MRI-targeted prostate biopsy with a PI-RADS score ≥3.
- Logistic regression was used to estimate the risk of PI-RADS 4 or 5 assignment and the associated risk of GG ≥2 disease.
Main Results:
- A two-fold variation in the probability of PI-RADS 4 or 5 assignment was observed across sites, persisting after risk adjustment (heterogeneity p < 0.001).
- Significant differences in the absolute risk of GG ≥2 disease for PI-RADS 4 (23%-68%) and PI-RADS 5 (49%-87%) were found (heterogeneity p < 0.001).
- The study included 7325 biopsies from 7320 unique patients, reflecting typical clinical use of mpMRI despite biopsy limitations.
Conclusions:
- Wide institutional variation exists in PI-RADS score assignment and the subsequent detection of significant prostate cancer (GG ≥2).
- This variability directly impacts patient counseling and risk stratification, potentially leading to suboptimal clinical management.
- Standardization of mpMRI performance and interpretation is essential to improve consistency and reliability in prostate cancer diagnosis and care.
