To investigate whether presence of multifocality on multi-parametric magnetic resonance imaging (mpMRI) would increase the likelihood of detecting clinically-significant prostate cancer (csPCa) in a PI-RADS 4 lesion.
We identified patients with at least one PI-RADS 4 lesion who underwent mpMRI-ultrasound fusion prostate biopsy. Patients were grouped into one of four cohorts - cohort 1 (a PI-RADS 4 index lesion and an additional PI-RADS 2 or 3 lesion), cohort 2 (single lesion with PI-RADS 4), cohort 3 (two or more PI-RADS 4 lesions), or cohort 4 (a PI-RADS 4 lesion and an index lesion with PI-RADS 5). We compared the rate of grade group (GG)≥2 pathology on targeted biopsy of PI-RADS 4 lesions between cohorts, and evaluated clinical and radiological factors associated with cancer detection.
The overall rate of GG≥2 pathology in the PI-RADS 4 lesions was 35.2%. The rate of GG≥2 pathology in the cohorts 1, 2, 3, and 4 was 21.7%, 36.3%, 49.1%, and 42.7%, respectively (p<0.001). On multivariable analysis, age (OR1.06, p<0.001), clinical stage T2 (OR1.59, p=0.03), prostate-specific antigen density (OR1.43, p<0.001), peripheral zone lesion (OR1.62, p=0.04), and study cohort (cohort 2 vs. 1, OR1.93, p=0.006; and cohort 3 vs. 1, OR3.28, p<0.001) were significantly associated with the risk of GG≥2 in the PI-RADS 4 lesion.
On targeted biopsy of the PI-RADS 4 lesions, the proportion of GG≥2 pathology is approximately 35%. Rate of GG≥2 detection in PI-RADS 4 lesions might differ based on their location, multifocality, and PI-RADS classifications of other lesions identified.
Urology. 2019 Aug 13 [Epub ahead of print]
Kamyar Ghabili, Matthew Swallow, Rachael L Sherrer, Jamil S Syed, Ghazal Khajir, Jennifer B Gordetsky, Michael S Leapman, Soroush Rais-Bahrami, Preston C Sprenkle
Department of Urology, Yale University School of Medicine, New Haven, CT., Department of Urology, University of Alabama at Birmingham, Birmingham, AL., Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Pathology, University of Alabama at Birmingham, Birmingham, AL., Department of Urology, University of Alabama at Birmingham, Birmingham, AL; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL., Department of Urology, Yale University School of Medicine, New Haven, CT. Electronic address: .