Multiparametric MRI findings, PI-RADS scores, and gleason scores in prostate cancer patients at Kumasi, Ghana: a cross-sectional analysis

Prostate cancer is a major cause of cancer-related morbidity and mortality in men, affecting about 2.3 million individuals every five years globally. Evaluating the diagnostic performance of multiparametric MRI (mpMRI) and the Prostate Imaging Reporting and Data System (PI-RADS) against histopathological grading is crucial for optimal management. This study examined the relationship between mpMRI findings, PI-RADS scores, and Gleason scores in patients with prostate cancer. In this cross-sectional study, 76 men with prostate cancer underwent mpMRI. Data were analyzed using STATA and R software. Spearman’s rank correlation was employed to assess associations between PI-RADS and Gleason scores. Receiver operating characteristic (ROC) analysis was performed to evaluate the ability of imaging parameters to stratify tumor aggressiveness within a cancer-positive cohort. One-way ANOVA tested differences in mean apparent diffusion coefficient (ADC) values across Gleason score and International Society of Urological Pathology (ISUP) grade groups, with p ≤ 0.05 considered statistically significant. A weak but statistically significant positive correlation was observed between PI-RADS and Gleason scores (r = 0.31, p = 0.007). PI-RADS 5 was predominantly associated with Gleason scores 7, 8, and 9, with proportions of 78%, 76%, and 100%, respectively (p 7), PI-RADS 5 demonstrated high sensitivity (86.2%) but low specificity (27.7%), consistent with its strength in capturing aggressive tumors within a biopsy-confirmed cohort. ADC values showed a moderate inverse correlation with Gleason grades (r = − 0.47, p < 0.001) and ISUP grades (r = − 0.43, p = 0.003), with progressively lower ADC values in higher-grade tumors. Higher PI-RADS categories and lower ADC values were associated with increasing histopathological aggressiveness in this cohort of biopsy-proven prostate cancer patients. These findings support the potential role of mpMRI in disease stratification, but should be interpreted cautiously given the cancer-only study population and skewed PI-RADS distribution. Larger prospective studies are required to validate these findings in mixed-suspicion cohorts.