A correlation of PI-RADS score and pathological grading outcome post radical prostatectomy: A retrospective review
Keywords:Correlation, PI-RADS score, pathological grading, outcome, radical prostatectomy
Objective: To investigate the correlation between the PI-RADS score and the pathologic Gleason score in the final pathological grading and to detect risk factors associated with the outcomes.
Materials and Methods: Data from January 2017 to September 2019 were reviewed. Inclusion criteria included patients who had undergone standard protocol prostate magnetic resonance imaging (MRI) in King Chulalongkorn Memorial Hospital and underwent radical prostatectomy during the period. Data collected were age, PI-RADS score, Gleason score (GS), prostate-specific antigen (PSA), prostate size, PSA density, lesion size, and extraprostatic extension (EPE) evident in MRI.
Results: One hundred and eight patients were included. PI-RADS was significantly associated with GS (Chi-Square p = 0.039). The percentage of significant tumors found in PI-RADS 3, 4, 5 were 66%, 86% 90% respectively. Analysis of independent risk factors only found PI-RADS 5 to have a statistically significant association with GS ≥ 7 (OR6.67 (1.24-35.71) p = 0.03). The cut-off value of lesion size ≥ 15 vs < 15 and PI-RADS 4 had a higher odds ratio than other parameters (OR 3.89 (0.82-18.41) p = 0.09, OR 3.29 (0.79-13.86) p = 0.11 respectively).
Conclusion: The PI-RADS scoring system was found to be highly associated with Gleason’s grading score. No association was found between any significant risk factor and significant prostate cancer. Lesion size could be used to combine with the PI-RADS scoring system in the detection of significant tumors. A high percentage of significant tumors were found with a PI-RADS 3 score and it may be worth taking a biopsy in the case of a PI-RADS 3 lesion.
Imsamran W, Chaiwerawattana A, Wiangnon S, Pongnikorn D, Suwanrungrung K, Sangrajrang S, et al. Cancer incidence in Thailand: Prostate. In: Imsamran W, Chaiwerawattana A, Wiangnon S, Pongnikorn D, Suwanrungrung K, Sangrajrang S, et al., editors. Cancer in Thailand Vol VIII, 2010- 2012. VIII, 2010-2012. Bangkok: National Cancer Institute Ministry of Public Health; 2012. p. 59-60.
Cooperberg MR, Pasta DJ, Elkin EP, Litwin MS, Latini DM, Du Chane J, et al. The University of California, San Francisco Cancer of the Prostate Risk Assessment score: a straightforward and reliable preoperative predictor of disease recurrence after radical prostatectomy. J Urol 2005;173:1938-42.
Hoffman RM. Clinical practice. Screening for pros- tate cancer. N Engl J Med 2011;365:2013-9.
Johansson JE, Adami HO, Andersson SO, Bergstrom R, Krusemo UB, Kraaz W. Natural history of localised prostatic cancer. A population-based study in 223 untreated patients. Lancet 1989;1:799-803.
Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA, et al. The 2014 International Society of Urological Pathology (ISUP) Consen- sus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol 2016;40:244-52.
Epstein JI, Allsbrook WC, Jr., Amin MB, Egevad LL, Committee IG. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol 2005;29:1228-42.
Yoo S, Kim JK, Jeong IG. Multiparametric magnetic resonance imaging for prostate cancer: A review and update for urologists. Korean J Urol 2015;56:487-97.
Barentsz JO, Weinreb JC, Verma S, Thoeny HC, Tem- pany CM, Shtern F, et al. Synopsis of the PI-RADS v2 Guidelines for Multiparametric Prostate Magnetic Resonance Imaging and Recommendations for Use. Eur Urol 2016;69:41-9.
Moore CM, Robertson NL, Arsanious N, Middleton T, Villers A, Klotz L, et al. Image-guided prostate biopsy using magnetic resonance imaging-derived targets: a systematic review. Eur Urol 2013;63:125-40.
Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 2015;313:390-7.
Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG. Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol 2015;68:438-50.
van Hove A, Savoie PH, Maurin C, Brunelle S, Gravis G, Salem N, et al. Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of well-designed studies. World J Urol 2014;32:847-58.
Barkovich EJ, Shankar PR, Westphalen AC. A Systematic Review of the Existing Prostate Imaging Reporting and Data System Version 2 (PI-RADSv2) Literature and Subset Meta-Analysis of PI-RADSv2 Categories Stratified by Gleason Scores. AJR Am J Roentgenol 2019;212:847-54.
Radtke JP, Schwab C, Wolf MB, Freitag MT, Alt CD, Kesch C, et al. Multiparametric Magnetic Resonance Imaging (MRI) and MRI-Transrectal Ultrasound Fusion Biopsy for Index Tumor Detection: Correlation with Radical Prostatectomy Specimen. Eur Urol 2016;70:846-53.
Lashay A, Gholivandan J, Sehri Y, Elahian A, Ghafari M. Correlation between mpMRI staging and final surgical pathology in prostate cancer. J Molec Biol Res 2020;10:6-11.
Kasivisvanathan V, Jichi F, Klotz L, Villers A, Taneja SS, Punwani S, et al. A multicentre randomised controlled trial assessing whether MRI-targeted biopsy is non-inferior to standard transrectal ultrasound guided biopsy for the diagnosis of clinically significant prostate cancer in men without prior biopsy: a study protocol. BMJ Open 2017;7:e017863.
Bratan F, Niaf E, Melodelima C, Chesnais AL, Souchon R, Mege-Lechevallier F, et al. Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study. Eur Radiol 2013;23:2019-29.
Washino S, Okochi T, Saito K, Konishi T, Hirai M, Kobayashi Y, et al. Combination of prostate imaging reporting and data system (PI-RADS) score and prostate-specific antigen (PSA) density predicts biopsy outcome in prostate biopsy naive patients. BJU Int 2017;119:225-33.
Distler FA, Radtke JP, Bonekamp D, Kesch C, Schlemmer HP, Wieczorek K, et al. The Value of PSA Density in Combination with PI-RADS for the Accuracy of Prostate Cancer Prediction. J Urol 2017;198:575-82.