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ORLANDO, FL USA ( - Recent advances in imaging technology allow to precisely characterize different malignancies. Multi-parametric MRI (MP-MRI) is an effective tool in the detection and staging of prostate cancer. Waingankar and colleagues performed the first study to compare all three currently existing MP-MRI scoring systems: Prostate Imaging Reporting and Data System (PI-RADS), 5-point Likert scale (5PLS), and the NIH MP-MRI cancer suspicion scoring system.

auaAll participants underwent a 3T prostate MRI with endorectal coil, including a T2, DWI, and DCE sequences. All images were reviewed by 3 experienced GU radiologists, who assigned a score using the 5PLS, PI-RADS, and NIH scoring systems. The modified NIH score is based on lesion suspicion in each MRI sequence (positive (+1), mild (+0.5), or negative (0)), with an overall impression based on the sum of the three sequences. PI-RADS and 5-point Likert scores are based on the 2012 ESUR guidelines. Participants with suspicious findings underwent MR/TRUS fusion biopsy followed by a 12-core biopsy. All scores and biopsy data was collected prospectively.

The study included a total 186 participants who underwent MR/TRUS fusion biopsy for 276 lesions. One hundred four participants had 110 positive lesions, and 60 participants had both negative targeted and standard biopsies. All three scoring systems performed better than the reference AUC of 0.5 (p < 0.0001). Comparison of all three scoring systems demonstrated no significant differences on lesion- or patient-based analysis. On lesion-based sub-analysis, direct comparison of 5PLS with NIH score showed significantly different ROC curves (p=0.009).

Currently, there are no accepted standards to report MP-MRI of the prostate as no study has compared all three scoring systems in the same patient population. The 5-point Likert scale, PI-RADS score, and NIH cancer suspicion scoring systems all performed well in predicting prostate cancer on MR/TRUS fusion guided prostate biopsy. There were no significant differences on comparison of all three scoring systems.

Presented by Nikhil Waingankar, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA

Baltimore, MD USA

Written by Zhamshid Okhunov, MD, University of California (Irvine), and medical writer for


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