The Value of Low Prostate Imaging—Reporting and Data System (PI-RADS) Scores in Preventing Unnecessary Prostate Biopsies

• Main Authors: Dong-Soo Kim, Sung-Kyoung Moon, Joo-Won Lim, Seung-Hyun Jeon, Sang-Hyub Lee
• Format: Article
• Language: English
• Published: MDPI AG 2021-04-01
• Series: Medicina
• Subjects: prostate cancer; multiparametric magnetic resonance imaging; image-guided biopsy; prostate specific antigen; cancer screening
• Online Access: https://www.mdpi.com/1648-9144/57/5/413
• ISSN: 1010-660X; 1648-9144

<i>Background and Objectives</i>: Magnetic resonance imaging (MRI) and the Prostate Imaging-Reporting and Data System (PI-RADS) have become essential tools for prostate cancer evaluation. We evaluated the ability of PI-RADS scores in identifying significant prostate cancer, which would help avoid unnecessary prostate biopsies. <i>Materials and Methods</i>: Patients with prostate-specific antigen (PSA) levels ≤ 20 ng/mL, who underwent prostate MRI for evaluation from January 2018 to November 2019, were analyzed. Among them, 105 patients who received transrectal ultrasonography (TRUS)-guided biopsy were included. PSA, PI-RADS scores (low 1–2, high 3–5), biopsy results, and Gleason scores (GS) were evaluated. Biopsies with GS higher than 3 + 4 were considered as significant cancers and biopsies with no cancer or Gleason 3 + 3 were considered insignificant or no cancers. <i>Results</i>: Among the 105 patients, 45 patients had low PI-RADS and 60 had high PI-RADS scores. There were no patients with significant prostate cancer in the low PI-RADS groups. For the high PI-RADS group, 28 (46.7%) patients had significant cancer and 32 (53.3%) had insignificant or no cancer. The sensitivity and specificity of high PI-RADS to detect significant cancer was 100% and 58.4%, respectively. Positive predictive value was 46.7% and negative predictive value was 100%. <i>Conclusions</i>: Low PI-RADS scores on MRI did not show significant prostate cancer and surveillance should be considered in selected cases to prevent unnecessary invasive procedures and overdiagnosis.