PET/MRI therefore makes it possible to improve the accuracy of diagnosis for patients with prostate cancer and to avoid unnecessary invasive examinations, but provided that the correct scale is used.
The Prostate Imaging Reporting and Data System (PI-RADS) is a 5-point scale used to evaluate suspected prostate cancer on MRI images. PI-RADS category 3, which presents an unclear suggestion of clinically significant prostate cancer, remains a “diagnostic challenge.” Although current guidelines recommend biopsy in this situation, less than 20% of lesions classified as PI-RADS 3 correspond to clinically significant prostate cancer.
A Diagnostic Solution to the PI-RADS 3 Lesion Dilemma
“PI-RADS 3 lesions present a dilemma for both urologists and patients because immediate biopsy is often unnecessary; however, an active surveillance strategy could also lead to missing diagnoses of clinically significant prostate cancer”summarizes one of the lead authors, Dr Hongqian Guo, urologist at Nanjing Hospital: “Therefore, specifically excluding prostate cancer among PI-RADS 3 lesions has significant clinical implications. »
The study is conducted on 56 men with PI-RADS 3 lesions, who underwent 68Ga-PSMA PET/MRI. After imaging, all patients underwent a prostate biopsy to assess whether they had clinically significant prostate cancer. These examinations reveal that:
- clinically significant prostate cancer was detected by biopsy in 8 of 56 patients, or 14% of participants;
- with PET/MRI, 40 out of 48 participants, or 83%, could have avoided unnecessary biopsies, at the risk of missing 1 clinically significant prostate cancer among the 8 identified via biopsy, or approximately 12%.
The researchers conclude that “the additive value » of 68Ga-PSMA PET/MRI in the classification of PI-RADS 3 lesions and suggest that in the future and as far as possible, “PI-RADS 3” patients be referred to
