Correlation Between PI-RADS Score And Biopsy Results And Pathological Features Of Prostate Cancer

Objective: To explore the role of Prostate imaging reporting and data system(PI-RADS)in the diagnosis of prostate cancer(PCa)and the value of predicting biopsy results,as well as the correlation between PI-RADS score and pathological features of PCa patients.To verify the relationship between the imaging features of PCa and the diagnosis and pathology of PCa,and to promote the clinical application and value of prostate PIRADS.Methods: 1.Patients with prostate biopsy: A total of 1242 patients who underwent anterior gland biopsy in Northern Jiangsu People’s Hospital from May 2013 to July 2020 were collected.According to the pathological results of the biopsy,the patients were divided into positive group and negative group,as well as clinically significant prostate cancer(csPCa)group and non-clinically significant prostate cancer(noncsPCa)group.The inclusion criteria were as follows:(1)patients who underwent transperineal prostate biopsy in our hospital,(2)3.0T multi-parameter nuclear magnetic resonance(mp MRI)examination and PI-RADS score were performed in our hospital before biopsy.Exclusion criteria:(1)previous prostate biopsy history,(2)lack of clinical data,(3)mp MRI examination more than 1 month from prostate biopsy,(4)PSA unknown or PSA > 100ng/ml.The clinical data,PI-RADS score and pathological results of all patients included in the study were collected.To explore the risk factors of PCa and csPCa in biopsy results,and further use the receiver operating characteristics(ROC)curve and line chart to analyze the accuracy of different indexes to predict the biopsy results.2.Prostate cancer patients: PCa patients diagnosed in Northern Jiangsu People’s Hospital from May 2013 to July 2020 were collected.Some of them underwent radical prostatectomy(RP).The patients were divided into biopsy group(n = 587)and RP group(n = 247)according to pathological examination.Inclusion criteria:(1)PCa patients diagnosed by prostate biopsy in our hospital.(2)3.0T mp MRI and PIRADS score before prostate biopsy in our hospital.Exclusion criteria:(1)Adjuvant therapy for PCa before biopsy or RP.(2)PSA unknown or PSA > 100ng/ml.(3)Other pathological types of tumors.(4)RP was performed two months after mp MRI examination.The PI-RADS scores were divided into three groups: ≤ 3,4 and 5.To evaluate the correlation between PI-RADS score and ISUP grade and the accuracy of PI-RADS score in predicting csPCa and high-grade PCa for PCa patients.For RP group,to further explore the relationship between PI-RADS score and postoperative pathological upgrade or downgrade,positive surgical margin,seminal vesicle invasion and lymph node metastasis.Results: 1.Prostate biopsy patients: 1242 prostate biopsy patients were included in this study,the positive 587 cases,rate was 47.3%;csPCa was 464 cases,the detection rate of csPCa was 37.6%.Spearman correlation analysis showed that there was a positive correlation between PI-RADS score and PCa and csPCa(r = 0.609,P < 0.001 and r = 0.642,P < 0.001).Univariate and multivariate analysis showed that age,PSAD and PI-RADS scores were all risk factors for PCa and csPCa(P < 0.001).A line chart model for predicting PCa and csPCa was established by using these three factors.ROC curve analysis showed that PI-RADS score combined with age and PSAD,had high accuracy in predicting PCa and csPCa in patients with biopsy(area under PCa: curve(AUC)= 0.877 and csPCa: AUC= 0.906).2.Patients with prostate cancer:(1)PCa by biopsy: PI-RADS scores ≤3,4 and 5 were 122,111 and 354 cases,respectively.There were also statistically significant differences in the composition ratio of International Society of Uropathology(ISUP)grade among the three groups(P <0.001),and there was a positive correlation between PI-RADS scores and ISUP grade(r=0.512,P <0.001).The AUC of the combination of PI-RADS score and PSAD for predicting csPCa in PCa patients was 0.810 and 0.768 for predicting high grade PCa.(2)RP group: 72,63 and 112 patients with PI-RADS score ≤3,4 and 5,respectively.There was also a significant difference in the composition ratio of ISUP grade among the three groups(P <0.001),and there was also a positive correlation between PI-RADS score and ISUP grade(r=0.691,P <0.001).The AUC of the combination of PI-RADS score and PSAD for predicting csPCa in PCa patients was 0.862 and 0.743 for predicting high grade PCa in PCa patients.(3)Postoperative pathology of RP: 126 patients(51%)showed changes in ISUP grade after RP,among which 67 cases(27.1%)were upgraded and 59 cases(23.9%)were downgraded.There was no statistical difference in PI-RADS score composition between the two group(P=0.323).However,43.7%(31/72)of the patients with Gleason score(GS)3+3=6 showed pathological upgrade after RP.It was found that the proportion of patients with PI-RADS>3 was higher than that with PI-RADS≤3(P=0.008).After RP,106 patients(42.9%)had positive margins,30 patients(12.1%)had seminal vesicle invasion,and 12 of 59 patients(20.3%)had lymph node metastasis.It was found that the higher the PI-RADS score,the more likely it was to occur.Conclusion 1.The higher the PI-RADS score,the greater the possibility of PCa and csPCa in biopsy patients.Meanwhile,the combination of PI-RADS score and clinical indicators has a higher accuracy in predicting PCa in biopsy patients,especially csPCa.2.PI-RADS score is correlated with ISUP grade of PCa,and combined with PSAD can predict csPCa and high-grade PCa patients more accurately.At the same time,the higher the PI-RADS score,the higher the probability of patients with positive surgical margin after RP,seminal vesicle invasion,lymph node metastasis,and pathological upgrading of GS 3+3=6.