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Objective@#To evaluate the value of Prostate Imaging Reporting and Data System Version 2 (PI-RADS ) based biparametric magnetic resonance imaging (bpMRI) for predicting prostate biopsy results in patients with elevated prostate specific antigen (PSA).@*Methods@#The bpMRI from 539 patients who took transperineal template saturate biopsy from January 2015 to October 2017 were assessed retrospectively. The average age was 69.5 years old (44-88 years), with tPSA level of 7.23 ng/ml (4-10 ng/ml), f/t PSA of 0.183( 0.016-0.504), PSAD of 0.126 ng/ml2 ( 0.025-0.534 ng/ml2) , PV of 72.42 ml ( 18.71-199.51 ml). The age, PSA level, free/total PSA ratio, PSA density, prostate volume, and PI-RADS score of enrolled patients were analyzed for univariate analysis and their difference was compared by chi-square test, t-test. The multivariate logistic regression analysis was also performed through SPSS to select the independent risk factors for prostate cancer (PCa) and clinically significant cancer (csPCa). The receiver operating characteristic curves were also constructed to analyze the sensitivity and specificity of PI-RADS in PCa to explore the best cut-off value for the diagnosis of PCa and csPCa.@*Results@#A total of 539 patients were included in our study with 244 cases being positive and 295 cases being negative. In patients with positive results, 59 patients were diagnosed csPCa. According to univariate analysis results, the age(P<0.001) and PI-RADS score (P<0.001) of the positive patients were higher than the negative patients, and the difference was statistically significant. The age of the csPCa patients (P=0.023), PSAD (P=0.048) and PI-RADS scores (P<0.001) were higher than those of InsPCa patients, and f/t PSA (P=0.027) was lower than that of InsPCa patients with statistically significance. Multivariate logistic regression analysis demonstrated that f /t PSA (OR=2.283, P=0.049) and PI-RADS score (OR=9.046, P<0.001) were independent risk factors for positive biopsy results, while PSAD (OR=4.54, P=0.038) and PI-RADS score (OR=8.254, P<0.001) were independent risk factor for csPCa. The Yoden index analysis of different thresholds for prostate cancer detection indicated that PI-RADS 3 was the optimal threshold for the diagnosis of PCa, and PI-RADS 4 was the optimal threshold for the diagnosis of csPCa. Based on the combination of the above factors, the positive rate of prostate cancer was relatively high in patients with PI-RADS score ≥3 and f/t PSA<0.2 , which accounted for 86.6%(181/209). In contrast, the positive rate in patients with a PI-RADS score of ≤2 and f/t PSA≥0.2 was low, which accounted for 10.7%(6/56). The positive rate of csPCa was relatively high in patients with PI-RADS score≥4 and PSAD≥0.15 ng/ml2, which accounted for 76.0%(38/50). The positive rate of csPCa detected in patients with ≤3 and PSAD<0.15 ng/ml2 was low, which accounted for 0(0/359).@*Conclusions@#PI-RADS score could be used to reduce the unnecessary prostate biopsies in patients with elevated PSA when combined with other PSA related markers. Patients with a PI-RADS score of ≤3 and a PSAD ratio <0.15 ng/ml2 could avoid unnecessary biopsies.
ABSTRACT
Objective To evaluate the value of Prostate Imaging Reporting and Data System Version 2 (PI-RADS) based biparametric magnetic resonance imaging (bpMRI) for predicting prostate biopsy results in patients with elevated prostate specific antigen (PSA).Methods The bpMRI from 539 patients who took transperineal template saturate biopsy from January 2015 to October 2017 were assessed retrospectively.The average age was 69.5 years old (44-88 years),with tPSA level of 7.23 ng/ml (4-10 ng/ml),f/t PSA of 0.183(0.016-0.504),PSAD of 0.126 ng/ml2 (0.025-0.534 ng/ml2),PV of 72.42 ml (18.71-199.51 ml).The age,PSA level,free/total PSA ratio,PSA density,prostate volume,and PI-RADS score of enrolled patients were analyzed for univariate analysis and their difference was compared by chi-square test,t-test.The multivariate logistic regression analysis was also performed through SPSS to select the independent risk factors for prostate cancer (PCa) and clinically significant cancer (csPCa).The receiver operating characteristic curves were also constructed to analyze the sensitivity and specificity of PI-RADS in PCa to explore the best cut-off value for the diagnosis of PCa and csPCa.Results A total of 539 patients were included in our study with 244 cases being positive and 295 cases being negative.In patients with positive results,59 patients were diagnosed csPCa.According to univariate analysis results,the age(P ＜ O.001) and PI-RADS score (P ＜ 0.001) of the positive patients were higher than the negative patients,and the difference was statistically significant.The age of the csPCa patients (P =0.023),PSAD (P =0.048) and PI-RADS scores (P ＜ 0.001) were higher than those of InsPCa patients,and f/t PSA (P =0.027) was lower than that of InsPCa patients with statistically significance.Multivariate logistic regression analysis demonstrated that f/t PSA (OR =2.283,P =0.049) and PI-RADS score (OR =9.046,P ＜ 0.001) were independent risk factors for positive biopsy results,while PSAD (OR =4.54,P =0.038) and PI-RADS score (OR =8.254,P ＜ 0.001) were independent risk factor for csPCa.The Yoden index analysis of different thresholds for prostate cancer detection indicated that PI-RADS 3 was the optimal threshold for the diagnosis of PCa,and PI-RADS 4 was the optimal threshold for the diagnosis of csPCa.Based on the combination of the above factors,the positive rate of prostate cancer was relatively high in patients with PI-RADS score ≥3 and t/t PSA ＜ 0.2,which accounted for 86.6％ (181/209).In contrast,the positive rate in patients with a PI-RADS score of ≤2 and f/t PSA≥0.2 was low,which accounted for 10.7％ (6/56).The positive rate of csPCa was relatively high in patients with PI-RADS score≥4 and PSAD≥0.15 ng/ml2,which accounted for 76.0％ (38/50).The positive rate of csPCa detected in patients with ≤ 3 and PSAD ＜ 0.15 ng/ml2 was low,which accounted for 0 (0/359).Conclusions PI-RADS score could be used to reduce the unnecessary prostate biopsies in patients with elevated PSA when combined with other PSA related markers.Patients with a PI-RADS score of ≤ 3 and a PSAD ratio ＜0.15 ng/ml2 could avoid unnecessary biopsies.
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Objective To compare the diagnostic accuracy of clinically significant prostate cancer by general radiologist and uroradiology specialist based on the Prostate Imaging Reporting and Data System (PI-RADS).Methods A total of 45 men from Beijing United Family Hospital and Clinics undergoing prostate mpMRI examination and subsequent MRI-targeted biopsy were included in the study.The age of patients was (60.0 ± 8.0) years,the median PSA level was 7.2 ng/ml (1.2-95.8 ng/ml) and the median prostate volume was 45.0 ml (18.3-127.0 ml).The general radiologists from Beijing United Family Hospital and Clinics made the diagnosis according to PI-RADS 2.0.One uroradiology specialist from Beijing Anzhen hospital reviewed all the mpMRIs retrospectively and marked new PI-RADS score based on PI-RADS 2.0.The PI-RADS ≥ 3 lesion was recognized as suspicious of clinically significant prostate cancer.The distribution of PI-RADS score from different doctors and the diagnostic accuracy of clinically significant prostate cancer was compared.Results All the 45 patients underwent MRI-targeted cognitive biopsy and 14 cases of prostate cancer were detected,including 9 cases of clinically significant prostate cancer.There was no significant difference in the distribution of PI-RADS by general radiologist and uroradiology specialist (P =0.064).82.8％ (37/45) and 37.8％ (17/45) patients were diagnosed with PI-RADS ≥ 3 by general radiologist and uroradiology specialist respectively.The interobserver agreement was only 17.8％ (8/45).The positive predictive value of PI-RADS≥3 was 35.1％ (13/37) and 76.5％ (13/17) for prostate cancer by general radiologist and uroradiology specialist respectively,and for clinically significant prostate cancer,the positive predictive value of PI-RADS ≥ 3 was 21.6％ (8/37) and 52.9％ (9/17) respectively.Conclusions Uroradiology specialist achieved significantly superior in predictive value of PI-RADS for clinically significant prostate cancer compared with general radiologist.In the experienced centers,MRI-targeted biopsy could be performed only on high PI-RADS score lesions,thus to reduce unnecessary biopsies and to avoid over diagnosis and over treatment of prostate cancer.