Prostate imaging reporting and data system version 2.1 as a predictor of clinically significant and aggressive...

Area of Science:

• Urology
• Radiology
• Oncology

Background:

• Rising global prostate cancer incidence necessitates improved diagnostic tools.
• Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 is evaluated for its efficacy.
• Radical prostatectomy (RP) pathology serves as the reference standard.

Purpose of the Study:

• To assess PI-RADS v2.1 performance in detecting clinically significant prostate cancer (csPCa).
• To identify high-risk patients and predict adverse pathological outcomes.
• To correlate PI-RADS scores with radical prostatectomy (RP) findings.

Main Methods:

• Retrospective study of 190 men undergoing preoperative multiparametric prostate magnetic resonance imaging (mpMRI) followed by RP.
• Independent PI-RADS scoring by two fellowship-trained radiologists.
• Correlation of PI-RADS scores with RP pathology results.

Main Results:

• Higher PI-RADS scores strongly correlate with higher Gleason scores and adverse pathological outcomes (P<0.001).
• PI-RADS ≥4 offers a good balance of sensitivity and specificity for csPCa detection (accuracy 0.78-0.81).
• mpMRI improved risk prediction, increasing concordance index (C-index) and area under the curve (AUC) for csPCa detection.

Conclusions:

• PI-RADS v2.1 reliably predicts csPCa and aggressive disease, offering value beyond clinical parameters.
• PI-RADS ≥4 is an optimal threshold for csPCa detection; PI-RADS 5 identifies highest-risk patients.
• MRI-integrated assessment aids risk stratification, active surveillance, and surgical planning.