Combining clinical and MRI data to manage PI-RADS 3 lesions and reduce excessive biopsy

BACKGROUND: Prostate Imaging Reporting and Data System version 2 (PI-RADS V2) 3 category lesions are of intermediate status with an equivocal risk of presenting clinically significant prostate cancer (csPCa). How to avoid excessive biopsies while improving the csPCa detection rate in these lesions has always been a clinical problem that needed to be solved. The purpose of this study is to explore the csPCa diagnostic value of clinical and magnetic resonance imaging (MRI) data for peripheral and transitional zone (PZ and TZ, respectively) PI-RADS 3 lesions to aid in clinical decision-making and reduce excessive biopsies. METHODS: From March 2016 to October 2018, a total of 629 men who underwent a prostate MRI and subsequently biopsy were enrolled. Two radiologists (with 3 and 7 years of experience, respectively) independently reviewed and scored all images using the PI-RADS V2 scoring criteria. Clinical and MRI data of men with PI-RADS 3 index lesions were collected by another radiologist. Univariate and multivariate analyses were performed to identify the risk factors of csPCa. RESULTS: , respectively). CONCLUSIONS: CsPCa was detected at a relatively high rate in PI-RADS 3 PZ lesions. Combining PSAD and age could help to reduce excessive biopsies of such lesions. CsPCa is unlikely to be detected in PI-RADS 3 TZ lesions; thus, active surveillance may be an optimal choice for these lesions, especially among patients without high-risk factors.