AUA 2018: The More You See, The More You Miss: Association Between PI-RADS Score of the Index Lesion and Multi-Focal, Clinically Significant Prostate Cancer

San Francisco, CA ( An extremely important consequence of our growing comfort with MRI-fusion targeted prostate biopsies is that systematic biopsies appear to be less important in some men. The results of the recent PRECISION trial, in fact, show that targeted biopsies alone may be a suitable way to detect clinically significant prostate cancer (csPC) in men undergoing diagnostic biopsies. The question lingers, though, about how much these targeted biopsies are potentially missing.

The authors of this poster sought to answer that question by evaluating the association between PIRADS score and multifocal csPC in men undergoing both targeted and systematic biopsies. 343 men were identified, and the detection of csPC outside of the index MRI lesion in this cohort was 30%. Certainly not an insignificant proportion! 

As might be expected, patients with higher PIRADS scores (indicating higher likelihood of csPC) did, in fact, have a higher likelihood of harboring multifocal csPC as well – up to 80% in PIRADS 5 lesions (see poster image). The authors note that the accuracy of PIRADS scoring in ruling out multifocal disease is low – 30% of patients will continue to have csPC outside of the MRI index lesion. These results are extremely important to keep in mind for all practitioners using MRI-fusion biopsies and for those who are considering focal therapy for prostate cancer. MRI-based targeting is helpful, but may not be giving us the full story.

UroToday AUA2018 PIRADS

Presented by: Armando Stabile; Milan, Italy
Co-Authors: Paolo Dell'Oglio, Francesco De Cobelli, Antonio Esposito, Giorgio Gandaglia, Nicola Fossati, Giorgio Brembilla, Giulia Cristel, Gianpiero Cardone, Federico Dehò, Andrea Losa, Nazareno Suardi, Tommaso Maga, Franco Gaboardi, Alessandro Del Maschio, Milan, Italy, Shahrokh F. Shariat, Vienna, Austria, Francesco Montorsi, Alberto Briganti, Milan, Italy

Written by:  Shreyas Joshi, MD, Fox Chase Cancer Center, Philadelphia, PA, @ssjoshimd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA