Photo Credit: mr.suphachai praserdumrongchai

The following is a summary of “Natural history of PIRADS-2 lesions on serial multiparametric magnetic resonance imaging: Real-life data from an Academic Center,” published in the September 2024 issue of Urology by Esen et al.

The natural progression of lesions classified as PIRADS-2 on multiparametric magnetic resonance imaging (mpMRI) remains inadequately characterized. This study aimed to investigate the longitudinal behavior of PIRADS-2 index lesions by utilizing serial mpMRI scans to determine the rates of MRI score upgrades and the incidence of prostate cancer (PCa) detection. 

Researchers retrospectively analyzed data from 214 biopsy-naïve patients with initial PIRADS-2 lesions who underwent at least one follow-up mpMRI. Of these, 172 patients with verified PIRADS-2 lesions according to PIRADS v2.1 were included. MRI progression was defined as an upgrade to any PIRADS score ≥3 on follow-up imaging. Histopathological outcomes were reviewed for patients who underwent biopsy following MRI progression. The cohort comprised 172 patients with a mean age of 60.1 ± 8.6 years and a median baseline PSA of 4.7 ng/dl (IQR: 3.3–6.7). MRI progression was observed in 54 patients (31.4%), with 37 lesions upgraded to PIRADS-3, 16 to PIRADS-4, and one to PIRADS-5. Multivariate logistic regression identified a PSA increase of ≥25% during follow-up as the sole predictor of MRI upgrade (P = 0.019, OR = 2.384). 

Of the 54 patients with MRI progression, 30 underwent prostate biopsy, which revealed PCa in 15 cases: 5 with ISUP grade 1 and 10 with ISUP grade 2. These findings suggest that nearly one-third of PIRADS-2 lesions may progress to higher PIRADS scores over time, particularly when accompanied by a significant PSA increase. Furthermore, PCa was identified in 50% of patients who were biopsied following MRI progression. Serial mpMRI is recommended for monitoring patients with a PSA increase of ≥25%, and biopsy should be considered if MRI progression is detected.

Source: sciencedirect.com/science/article/abs/pii/S1078143924005787