![]() Data were obtained regarding age, ethnicity, pre-biopsy serum PSA level (ng/ml), maximum PI-RADS score obtained on a multiparametric MRI, and calculated PSA density (PSAD) expressed as ng/ml/cc), and the final pathology results. A total of 312 evaluable patients were ultimately included. Patients were excluded unless the maximal PI-RADS score was 3 or higher, and appropriate follow-up information and demographic data were complete. After de-identification, a retrospective analysis was performed of all MRI-fusion guided biopsies performed between October 16, 2017, and November 15, 2021, numbering 320 in total. Įxempt status was granted on August 2, 2021, by the Clinical Research Review Committee of Lowell General Hospital. The mpMRI can be used to help target a suspicious MRI lesion, maximizing the likelihood of the biopsy obtaining tissue from the area of interest. PI-RADS 5: Clinically significant cancer is highly likely to be present. PI-RADS 4: Clinically significant cancer is likely to be present PI-RADS 3: Clinically significant Cancer is equivocal (intermediate risk) Pi-RADS 2: Clinically significant disease is unlikely to be present PI-RADS 1: Clinically significant disease is highly unlikely to be present The specific definition of the various PI-RADS findings are as follows: These advances have helped increase the likelihood of tumor detection and staging. Further refinements have improved accuracy and decreased inter-observer variation since. The first version of the Prostate Imaging-Reporting and Data System (PI-RADS v1) was published in 2012. Advances including 3 Tesla magnets and improved software have increased the sensitivity and specificity of locating likely sites of prostate cancer. MRI has become an important adjunct in the decision-making process. Management of this intermediate risk group has proved challenging to many clinicians. As MRI has become more frequently used as a diagnostic adjunct, our group decided to examine more closely the characteristics of patients who underwent a prostate biopsy with mpMRI findings of PI-RADS 3. These must be balanced against the risks of a biopsy including sepsis, cost, the possibility of false positive or negative results, and discomfort. Multiple strategies have evolved to help decide when a biopsy of the prostate should be performed. Urologists face a difficult challenge in deciding who should undergo a biopsy to evaluate for prostate cancer. This demonstrates that comparable diagnostic mpMRI/biopsy quality may be found in the community setting. Our findings, from a single, large, community hospital with a diverse ethnic makeup, parallel the findings of large trials done at academic centers of excellence. We suggest that many factors (such as rate of rise of PSA over time, family history, and rectal examination findings) be considered in addition to the MRI PI-RADS score to advise whether or not to proceed with a biopsy of the prostate. ![]() Conclusions: We found that many men with PI-RADS 3 findings on multiparametric MRI do, in fact, have clinically significant prostate cancer. In the men with cancer, we analyzed and report the relationship to age, ethnicity, PSA density, and the presence or absence of cribriform findings. Results: A total of 34% of the men with PI-RADS 3 lesions were found to have Grade Group ≥ 1, with 15.6 % demonstrating Grade Group ≥ 2. Of the subset with scores of PI-RADS 3 who underwent biopsy (N = 32), 100 percent were biopsied using an MRI-guided fusion technique, greatly raising the likelihood that the MRI lesion was, in fact, the area sampled. Methods: A retrospective 4-year data and quality analysis was performed of 312 evaluable men undergoing prostate MRI. The goal of our paper was to evaluate the likelihood of finding cancer of clinical significance in this group. ![]() PI-RADS 3 lesions often prove to be a diagnostic challenge, and many men are advised not to proceed with a biopsy based on this finding. The MRI PI-RADS system stratifies the risk of finding cancer on prostate biopsy. Introduction: With the advent of multiparametric MRI (mpMRI), clinicians added an important tool for helping to decide whether a man should undergo a prostate biopsy. ![]()
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