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Updated: May 9, 2025
06:08
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
106
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.
European Urology Oncology
|May 3, 2025
Summary
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.
