Utility of multiparametric magnetic resonance imaging with PI-RADS version 2 in prostate cancer patients eligible for active surveillance: which radiological characteristics can predict unfavorable disease?

Abstract Background To investigate the utility of multiparametric magnetic resonance imaging (mpMRI) using Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) scoring in prostate cancer patients eligible for active surveillance (AS). Methods The records of patients who underwent mpMRI prior to radical prostatectomy between 2014 and 2018 were reviewed. All met the Prostate Cancer Research International AS criteria. PI-RADSv2 scores were assigned to 12 prostate regions. Unfavorable disease was stratified according to the American Joint Committee on Cancer (AJCC) prognostic scale as stages IIB (Gleason score [GS] 3+4 and pathologic T2) and IIC-III (GS≥4+3 or pathologic T3). Results Of 376 eligible patients, 184 (48.9%), 129 (34.3%), and 63 (16.8%) had AJCC I, IIB, and IIC-III disease, respectively. Patients with IIC-III disease were older and had higher prostate-specific antigen density than those with I or IIB disease. PI-RADS 5 lesions were more frequent in patients with stage IIC-III than in patients with I or IIB disease. Multivariable analysis revealed that ≥2 lesions with PI-RADS 5 score was an independent predictor for unfavorable disease (hazard ratio [HR]=3.612, p Conclusion mpMRI with PI-RADSv2 has a high negative predictive value in prostate cancer patients eligible for AS. Multiple PI-RADS 4-5 lesions were associated with unfavorable disease compared to solitary lesions. Multiple PI-RADS 5 lesions were strongly associated with GS ≥4+3 or pathologic T3 disease. Targeted biopsy or radical treatment should be considered in these patients.