Skip to main content

Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary?

Publication ,  Journal Article
Felker, ER; Raman, SS; Margolis, DJ; Lu, DSK; Shaheen, N; Natarajan, S; Sharma, D; Huang, J; Dorey, F; Marks, LS
Published in: AJR Am J Roentgenol
December 2017

OBJECTIVE: The objective of our study was to determine the clinical and MRI characteristics of clinically significant prostate cancer (PCA) (Gleason score ≥ 3 + 4) in men with Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) category 3 transition zone (TZ) lesions. MATERIALS AND METHODS: From 2014 to 2016, 865 men underwent prostate MRI and MRI/ultrasound (US) fusion biopsy (FB). A subset of 90 FB-naïve men with 96 PI-RADSv2 category 3 TZ lesions was identified. Patients were imaged at 3 T using a body coil. Images were assigned a PI-RADSv2 category by an experienced radiologist. Using clinical data and imaging features, we performed univariate and multivariate analyses to identify predictors of clinically significant PCA. RESULTS: The mean patient age was 66 years, and the mean prostate-specific antigen density (PSAD) was 0.13 ng/mL2. PCA was detected in 34 of 96 (35%) lesions, 14 of which (15%) harbored clinically significant PCA. In univariate analysis, DWI score, prostate volume, and PSAD were significant predictors (p < 0.05) of clinically significant PCA with a suggested significance for apparent diffusion coefficient (ADC) and prostate-specific antigen value (p < 0.10). On multivariate analysis, PSAD and lesion ADC were the most important covariates. The combination of both PSAD of 0.15 ng/mL2 or greater and an ADC value of less than 1000 mm2/s yielded an AUC of 0.91 for clinically significant PCA (p < 0.001). If FB had been restricted to these criteria, only 10 of 90 men would have undergone biopsy, resulting in diagnosis of clinically significant PCA in 60% with eight men (9%) misdiagnosed (false-negative). CONCLUSION: The yield of FB in men with PI-RADSv2 category 3 TZ lesions for clinically significant PCA is 15% but significantly improves to 60% (AUC > 0.9) among men with PSAD of 0.15 ng/mL2 or greater and lesion ADC value of less than 1000 mm2/s.

Duke Scholars

Published In

AJR Am J Roentgenol

DOI

EISSN

1546-3141

Publication Date

December 2017

Volume

209

Issue

6

Start / End Page

1272 / 1277

Location

United States

Related Subject Headings

  • Risk Assessment
  • Retrospective Studies
  • Prostatic Neoplasms
  • Prostate-Specific Antigen
  • Nuclear Medicine & Medical Imaging
  • Neoplasm Grading
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Felker, E. R., Raman, S. S., Margolis, D. J., Lu, D. S. K., Shaheen, N., Natarajan, S., … Marks, L. S. (2017). Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary? AJR Am J Roentgenol, 209(6), 1272–1277. https://doi.org/10.2214/AJR.17.18008
Felker, Ely R., Steven S. Raman, Daniel J. Margolis, David S. K. Lu, Nicholas Shaheen, Shyam Natarajan, Devi Sharma, Jiaoti Huang, Fred Dorey, and Leonard S. Marks. “Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary?AJR Am J Roentgenol 209, no. 6 (December 2017): 1272–77. https://doi.org/10.2214/AJR.17.18008.
Felker ER, Raman SS, Margolis DJ, Lu DSK, Shaheen N, Natarajan S, et al. Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary? AJR Am J Roentgenol. 2017 Dec;209(6):1272–7.
Felker, Ely R., et al. “Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary?AJR Am J Roentgenol, vol. 209, no. 6, Dec. 2017, pp. 1272–77. Pubmed, doi:10.2214/AJR.17.18008.
Felker ER, Raman SS, Margolis DJ, Lu DSK, Shaheen N, Natarajan S, Sharma D, Huang J, Dorey F, Marks LS. Risk Stratification Among Men With Prostate Imaging Reporting and Data System version 2 Category 3 Transition Zone Lesions: Is Biopsy Always Necessary? AJR Am J Roentgenol. 2017 Dec;209(6):1272–1277.

Published In

AJR Am J Roentgenol

DOI

EISSN

1546-3141

Publication Date

December 2017

Volume

209

Issue

6

Start / End Page

1272 / 1277

Location

United States

Related Subject Headings

  • Risk Assessment
  • Retrospective Studies
  • Prostatic Neoplasms
  • Prostate-Specific Antigen
  • Nuclear Medicine & Medical Imaging
  • Neoplasm Grading
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging
  • Humans