Prostagram MRI in a Screening Population: PI-RADS or Likert?

The IP1-PROSTAGRAM study highlighted the potential of short biparametric "Prostagram" magnetic resonance imaging (bpMRI) scanning in screening for prostate cancer. We aimed to compare biopsy recommendation rates and accuracy of PI-RADSv2 with the Likert scale for detection of clinically significant and insignificant prostate cancer in men screened within IP1-PROSTAGRAM.Men aged 50-69 years were screened with Prostagram MRI. Scans were prospectively reported using both PI-RADSv2 (excluding dynamic contrast-enhanced sequence score) and 5-point Likert scores by expert uro-radiologists. Systematic and targeted transperineal biopsy was recommended if the scan was scored ≥3, based on either reporting system. The proportion of patients recommended for biopsy and detection rates for grade groups (GG) 1 and ≥2 were compared. Receiver operating characteristic (ROC) analysis was performed to compare performance.406 men underwent Prostagram MRI. Median age and PSA were 57 years (IQR 53-61) and 0.91 ng/mL (0.56-1.74), respectively. At MRI score ≥3, more patients were recommended for biopsy based on Likert criteria (94/406, 23% [95% CI 19.2-27.6%]) compared to PI-RADSv2 (72/406, 18% [14.2-21.9%]; p=0.03). For scores ≥4, PI-RADSv2 and Likert scales led to 43/406 (11%, 7.9%-14.1%) and 35/406 (9%, 6.2-11.9%) men recommended for biopsy (p=0.40). For GG≥2 detection, PIRADSv2 and Likert detected 22% (11.4-30.8%, 14/72) and 16% (9.5-25.3%, 15/94), respectively (p=0.56). For GG1 cancers detection these were 11% (4.3-19.6%, 7/72) vs 11% (4.7-17.8%, 9/94) (p=1.00). The accuracy of PI-RADS and Likert scale was similar (AUROC 0.64 vs 0.65, p=0.95).In reporting non-contrast-enhanced Prostagram MRI in a screening population, the PI-RADSv2 and Likert scoring systems were equally accurate; however, Likert scale use led to a more men undergoing biopsy without a subsequent increase in significant cancer detection rates. To improve reporting of Prostagram MRI, either the PI-RADS or a modified Likert scale or a standalone scoring system should be developed.This article is protected by copyright. All rights reserved.

Citation

Nikhil Mayor, David Eldred-Evans, Henry Tam, Heminder Sokhi, Anwar R Padhani, Martin J Connor, Derek Price, Martin Gammon, Natalia Klimowska-Nassar, Paula Burak, Emily Day, Mathias Winkler, Francesca Fiorentino, Taimur Shah, Hashim Uddin Ahmed. Prostagram MRI in a Screening Population: PI-RADS or Likert? BJU international. 2023 Aug 17

PMID: 37591614

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