The Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2) categorizes the likelihood of clinically significant prostate cancer (csPCa) on magnetic resonance imaging (MRI) and determines the diagnostic pathway. We aimed to determine csPCa and all PCa detection rates in each PI-RADSv2 category.
MEDLINE, EMBASE, and Cochrane databases were searched for prospective studies reporting the detection rates of csPCa or all PCa. Random-effects models were used to determine pooled detection rates of csPCa and all PCa for each PI-RADS category. The risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2. Meta-regression analysis was performed to identify factors affecting study heterogeneity.
Thirteen prospective studies including 4265 men who underwent MRI-targeted biopsy and/or systematic biopsy (SBx) for a PI-RADSv2 category≥ 3 or SBx for PI-RADS 1-2 were included. The pooled detection rates of csPCa monotonically increased for each PI-RADSv2 category, i.e., 4% (95% confidence interval [CI], 2-8%) for category 1-2; 17% (95% CI, 13-21%) for category 3; 46% (95% CI, 38-55%) for category 4; and 75% (95% CI, 73-78%) for category 5. Substantial study heterogeneity was noted in csPCa detection rates for categories 1-2 and 4, which were significantly affected by study subject selection (biopsy-naive patients only or not) and studies with a high risk of bias.
PI-RADSv2 can be useful for the stratification of the risk of csPCa in patients at risk of PCa, but the limitations in category 4 still remain.
The Journal of urology. 2020 Jul 27 [Epub ahead of print]
Kye Jin Park, Sang Hyun Choi, Ji Sung Lee, Jeong Kon Kim, Mi-Hyun Kim, In Gab Jeong
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea., Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea., Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.