AUA 2022: A Race-Stratified Analysis of the Accuracy of Prostate MRI in Biopsy Naive Men

( Julio Meza and team presented a brilliant case on the importance of accurate testing and the inclusivity of minority groups in medical research. Multiparametric MRI is an important tool used to detect clinically significant prostate cancer (Gleason grade groups 2-5) and works in tandem with the Prostate Imaging Reporting and Data System (PIRADS) to help with the reporting and imaging of prostate cancer. Several studies have proven the validity of PIRADS however, many of these studies used participants that were primarily White; this means that very little data has been published to show the efficiency of PIRADS in other minority groups. This study looked to change this by challenging the sensitivity and specificity of PIRADS by comparing data between White, Black, and Hispanic men.

Two center retrospective studies were completed on biopsy naïve men. Patients who had previous prostate biopsies, a history of prostate cancer, had a prostate greater than 100 grams on MRI, and a PSA greater than fifteen were all excluded. Of an available bank of 1,400 patients, only 280 patients applied to the study; the self-reported race documented information on their medical records was used to indicate patient race. There were 108 Black participants, 108 White participants, and 64 Hispanic participants. The following lists the distribution of the types of biopsies examined:

  • 80% UroNav fusion transrectal ultrasound (TRUS) biopsies with systematic and target cores taken
  • 18% TRUS guided systematic prostate biopsy
  • 2% Cognitive fusion.

The study used PIRADS v.2 for 92% of the participants, the rest of the patients were analyzed using on older versions of the PIRADS. Participating patients were split between factors such as PSA and age, as seen in the tables below.



The table below shows the proportion and comparative data of participants with Gleason grade group 2-5 prostate cancer by their respective race groups.


The data indicated that prostate cancers rates of Gleason grade groups 2-5 were similar. The table below shows the calculated statistics for sensitivity specificity, negative predictive value (NPV), and positive predictive value for Black vs White patients and Hispanic vs White patients. White and Black patients had relatively similar sensitivity and specificity values; comparison of Hispanic to White showed to be statistically significant, specifically when looking into sensitivity. PPV was similar between the Black to White comparison and the Hispanic to white comparison; however, NPV of Black patients to White patients was a bit low but the rate of Hispanic to White was noticeably lower.


Meza’s team conducted an area under the curve analysis (ACU) looking at three factors: clinical variables/base, PIRADS, and a combination of clinical variables and PIRADS. The clinical variables investigated additional factors such as digital rectal examinations, Log2[PSA] data, and age. The table below shows the results for the AUC analysis. Statistically significance was found only when base and PIRADS were combine and only so for White and Black race groups.


While going over the discussion points of the study, Meza explained that this study is largest of the PIRADS investigations that boasted a large Hispanic participant group. In terms of the strength of the data he explained that PIRADS v2 and v2.1 were 95% similar, which allows the results could be applicable clinically. The PIRADS AUC had additive data for two of the three race groups which helped create a more cohesive understanding of the trend within the results. He concluded by explaining the limitations of his study which were a small audience size and the fact that it is a retrospective study.

Although this study showed similar results for White and Black patients, it revealed harrowing information regarding Hispanic patients. Low sensitivity for Hispanics and no improvement in the AUC data for Hispanic men indicates that this race is prone to a delayed prostate cancer diagnosis. Studies such as this one proves one important point: the importance of including a wide and plentiful variety of different participants of different races. Cancer is a disease that spares no race therefore our data studies should spare no race group either. It is of the upmost importance that tests such as the PIRADS are examined and validated for accuracy to make sure that anyone of any race will be ablet to benefit and rest assured that the tools used by their physicians will be able to actually help.

Presented by: Julio Meza, MS4, Northwestern Feinberg School of Medicine, @julioandremeza on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, May 13 - 16, 2022, New Orleans, Louisiana

Written by: Seyed Amiryaghoub M. Lavasani, B.A., University of California Irvine, @amirlavasani_ on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.  


  1. Bass EJ, et al. Diagnostic accuracy of magnetic resonance imaging targeted biopsy techniques compared to transrectal ultrasound guided biopsy of the prostate: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. (2021)
  2. Henning, G. M. et al. Diagnostic Performance of Prostate Multiparametric Magnetic Resonance Imaging in African-American Men. Urology 134, 181–185 (2019).
  3. Pagniez MA, et al. Predictive Factors of Missed Clinically Significant Prostate Cancers in Men with Negative Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis. J Urol. 204, 24-32 (2020).