The following is a summary of “PI-RADS Version 2.0 Versus Version 2.1: Comparison of Prostate Cancer Gleason Grade Upgrade and Downgrade Rates From MRI-Targeted Biopsy to Radical Prostatectomy,” published in the September 2023 issue of Oncology by Yilmaz et al.
Accurate risk stratification of prostate cancer (PCa) using MRI/US fusion-guided targeted biopsy(TBx) can help doctors choose the best treatment for each patient.
Researchers performed a retrospective study to compare the PI-RADS 2.0 and 2.1 in terms of how often they predicted a change in the PCa grade group from MRI-targeted biopsy to radical prostatectomy(RP).
The study identified pts who had both MRI scans and MRI/ultrasound-fusion guided prostate biopsies (TBx) followed by RP within a year. A genitourinary radiologist interpreted the MRI results using PI-RADS v2.0 from May 2015 to March 2019 and PI-RADS v2.1 from April 2019 to March 2023. They compared the rates of upgrading and downgrading from TBx to RP using chi-square tests. Clinically significant cancer was defined as Gleason Grade (GG) ≥2.
The study included 308 patients (median age: 65 years; median PSA density: 0.16 ng/mL2). Comparing PI-RADS v2.0 (177 patients) and v2.1 (131 patients), there were no significant differences in upgrade rates (29% vs. 22%, P= 0.15), downgrade rates (19% vs. 21%, P= 0.76), clinically significant upgrade rates (14% vs. 10%, P= 0.27), or clinically significant downgrade rates (1% vs. 1%, P> 0.99). These results remained consistent when considering different PI-RADS categories, lesion zones, or patients without prior prostate cancer diagnosis (all P> 0.01). Among patients with Gleason Grade 2 (GG2) or Gleason Grade 3 (GG3) at RP (n=121 for v2.0; n=103 for v2.1), the agreement between TBx and RP was not significantly different between the v2.0 and v2.1 groups (53% vs. 57%, P= .51).
The study found that PI-RADS 2.0 and 2.1 were equally accurate in predicting changes in the PCa grade group from MRI-targeted biopsy to radical prostatectomy.