PI-RADS v2 and Adverse Prostate Cancer Outcomes: A Cross-cohort Replication Study Across Three Centers.

Area of Science:

• Radiology
• Oncology
• Urology

Background:

• Prostate cancer (PCa) diagnosis relies on Magnetic Resonance Imaging (MRI) and the Prostate Imaging-Reporting and Data System (PI-RADS).
• Limited follow-up data has hindered exploration of the association between PI-RADS and clinical outcomes.

Purpose of the Study:

• To investigate the association between PI-RADS scores and key clinical endpoints in prostate cancer.
• To evaluate the prognostic value of PI-RADS in diverse patient cohorts.

Main Methods:

• Retrospective analysis of three cohorts (Helsinki, Tampere, Lille) from the PI-RADS v2 era.
• Investigated associations between PI-RADS scores and prostate cancer-specific mortality (PCSM), overall survival (OS), metastasis-free survival (MFS), and biochemical recurrence (BCR).

Main Results:

• PI-RADS score 5 was significantly associated with PCSM in the Helsinki cohort (HR 18.4).
• PI-RADS score 5 also correlated with OS, MFS, and BCR across different cohorts.
• Biopsy Gleason Grade 5 and Charlson's Comorbidity Index were also associated with adverse outcomes.

Conclusions:

• A PI-RADS score of 5 is linked to a higher risk of adverse prostate cancer outcomes.
• These findings support the use of PI-RADS in clinical decision-making for PCa diagnosis and prognosis.
• The study highlights the prognostic utility of MRI-based PI-RADS scoring.