PI-RADS 4 or more: Active Surveillance no more.

The introduction of multiparametric Magnetic Resonance Imaging (mpMRI) has improved the diagnosis and risk stratification of intermediate and high-risk prostate cancer. In addition to diagnosis, mpMRI has increasing become a useful tool for monitoring prostate cancer risk of patients on active surveillance (AS) programs. A significant proportion of men on AS programs have suspicious lesions on mpMRI [1]. Accordingly, repeat mpMRI provides means of non-invasive assessment with the potential for fusion biopsy and preferential sampling of prostate cancer tissue. In 2012, the Prostate Imaging Reporting and Data System (PI-RADS) introduced standardized reporting of prostate mpMRI. PI-RADS 4 and 5 lesions have been classified as "clinically significant cancer is likely to be present" and "clinically significant cancer is highly likely" respectively. PI-RADS 4 and 5 lesions are being increasing correlated with intermediate and high-grade prostate cancer. As recently discussed in: "Gleason Pattern 4: Active Surveillance no more" [2], patients with intermediate-risk prostate cancer are not suitable for AS. In light of this, the presence of PI-RADS 4 or 5 lesions on men enrolled to AS programs for prostate cancer warrants concern. This article is protected by copyright. All rights reserved.

BJU international. 2016 Jun 22 [Epub ahead of print]

Marlon Perera, Nik Katelaris, Declan Murphy, Shannon McGrath, Nathan Lawrentschuk

Department of Surgery, Austin Health, University of Melbourne, Victoria, 3000., Department of Surgery, Austin Health, University of Melbourne, Victoria, 3000., Department of Surgery, St Vincent's Hospital, University of Melbourne, Victoria, 3000., Department of Surgery, Austin Health, University of Melbourne, Victoria, 3000., Department of Surgery, Austin Health, University of Melbourne, Victoria, 3000.