Effect of the PI-RADS score on adverse surgical outcomes in patients with prostate cancer after radical prostatectomy

Background. Multiparametric magnetic resonance imaging and Prostate Imaging Reporting and Data System (PI-RADS) are widely used to diagnose clinically significant prostate cancer. Meanwhile, PI-RADS diagnostic accuracy varies between 30 % for PI-RADS score 3 to 80 % for PI-RADS score 5. The value of PI-RADS scores in patients already diagnosed with prostate cancer remains unclear.

Aim. To evaluate the impact of PI-RADS score on adverse surgical outcomes: prostate cancer upstaging, increased Gleason score, lymph node metastases, positive surgical margin, and oncological outcomes in patients of the ISUP grade 1 group per the International Society of Urological Pathology (ISUP) scale who underwent radical prostatectomy.

Materials and methods. Forty patients with ISUP grade 1 prostate cancer underwent radical prostatectomy (robotic or laparoscopic). All patients underwent diagnostic multiparametric magnetic resonance imaging with PI-PADS score v2 (v2.1) prior to radical prostatectomy. PI-RADS 3 was determined in 14 (35 %), PI-RADS 4 – in 10 (25 %) and PI-RADS 5 – in 16 (40 %) patients, respectively. The age of patients was 62.7 ± 6.6 years. Stage cT2a was diagnosed in 19 (47.5 %), cT2b – in 5 (12.5 %), cT2c – in 11 (27.5 %), cT3a – in 5 (12.5 %) patients, respectively. Pelvic lymph node dissection was performed in 23 (57.5 %) cases. The median follow-up was 12.6 months.

Results. Upstaging events to pT3a occurred in 2 (15.2 %) patients with PI-RADS 3 lesions, in 5 (31.3 %) patients with PI-RADS 5 lesions; upstaging events to pT3b occurred in 1 (10 %) patient with PI-RADS 4 lesions, and in 1 (6.25 %) patient with PI-RADS 5 lesions. Increased Gleason score (GS) was observed in 22 (55 %) patients: GS increase ≥2 was diagnosed in 8 (57.1 %) patients with PI-RADS 3 lesions, in 3 (30 %) patients with PI-RADS 4 lesions, in 11 (68.7 %) patients with PI-RADS 5 lesions, respectively. Lymph node metastases were observed only in 1 (4.3 %) patient with PI-RADS 5 lesions. Positive surgical margin (>3 mm) was observed in 2 (12.4 %) patients with PI-RADS 5 lesions. Biochemical recurrence occurred in 1 (2.5 %) patient with PI-RADS 3 lesions. One-year biochemical recurrence-free survival was 97.5 %.

Conclusion. Increased PI-RADS score from 3 to 5 is accompanied by increased frequency of prostate cancer upstaging and Gleason score increase in patients with ISUP grade 1 prostate cancer. PI-RADS scores 3–5 can be important in selecting patients for nerve-sparing prostatectomy, pelvic lymph node dissection, and play a part in prediction of biochemical recurrence and lymph node metastasis.

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