Ullrich T, et al. - This paper entailed the examination of patients with Prostate Imaging Reporting and Data System (PI-RADS)-3-lesions (called ‘equivocal’ according to PI-RADS v2) in multiparametric prostate magnetic resonance imaging (mp-MRI) and MR-targeted plus systematic transrectal ultrasound-guided (TRUS-GB) biopsies as a reference standard. It was displayed that among patients with a PI-RADS, an overall score of 3 low-grade PCa Gleason score (GS) 3+3=6) could be noted. prostate cancer (PCa) with a GS ≥3+4=7 could be seen in mp-MRI with a high degree of certainty, GS ≥4+3=7 PCa was rare in PI-RADS-3-lesions. Such patients ought to receive follow-up MRI. Low prostate volume, and/or high prostate-specific antigen (PSA) density biopsy could be taken into account for patients with a combination of MRI aspects of extensive prostatitis and diffuse stromal hyperplasia.

Methods

• The enrollment included 120 consecutive patients with a PI-RADS overall score of 3 after mp-MRI (T2WI, DWI, DCE-MRI) at 3T and subsequent targeted MRI/US fusion-guided (FUS-GB) plus systematic 12-core TRUS-GB.
• The distribution of Gleason scores, location of PCa, and risk stratification by subgroup analyses were defined as endpoints prostate cancer (PCa) detection rates.

Results

• PCa was detected in 13 of 118 patients (detection rate 11%) including five patients with a Gleason score (GS) ≥3+4=7 (4.2%).
• 1.4% of the lesions within the transition zone (3/212) and 9.4% within the peripheral zone (6/64) were positive for PCa.
• The detection of PCa was noted in 54% MRI patterns of peripheral prostatitis combined with diffuse stromal hyperplasia.
• Prostate volume appeared to be prominently lower in PCa patients (p=0.015).
• In contrast, the variations in PSA levels were not statistically notable (p=0.87).
• Higher PSA density was illustrated in patients with PCa (0.19 vs. 0.12 ng/ml/ml).