Results from a PI-RADS-based MRI-directed diagnostic pathway for biopsy-naive patients in a non-university hospital

Abdom Radiol (NY). 2021 Dec;46(12):5639-5646. doi: 10.1007/s00261-021-03249-8. Epub 2021 Aug 20.


Purpose: To assess the safety and performance of a MRI-directed diagnostic pathway for patients with first-time suspicion of prostate cancer in a non-university hospital.

Methods: Between May 2017 and December 2018 all biopsy-naive patients examined in our hospital followed a MRI-directed diagnostic work-up algorithm based on PI-RADS score. In short, PI-RADS 1-2 was generally not biopsied and PI-RADS 3-5 was reviewed by a multidisciplinary team. Patients with PI-RADS 4-5 were all referred to biopsy, either transrectal ultrasound-guided biopsy or MRI in-bore biopsy for small tumors and for sites difficult to access. PI-RADS scores were compared to the histopathology from biopsies and surgical specimens for patients who had prostatectomy. Non-biopsied patients were referred to a safety net monitoring regimen.

Results: Two hundred and ninety-eight men were enrolled. 97 (33%) had PI-RADS 1-2, 44 (15%) had PI-RADS 3, and 157 (53%) had PI-RADS 4-5. 116 (39%) of the patients avoided biopsy. None of these were diagnosed with significant cancer within 2-3.5 years of safety net monitoring. Almost all high ISUP grade groups (≥ 3) were in the PI-RADS 4-5 category (98%). Prostatectomy specimens and systematic biopsies from MRI-negative areas indicated that very few clinically significant cancers were missed by the MRI-directed diagnostic pathway.

Conclusion: Our findings add to evidence that a MRI-directed diagnostic pathway can be safely established in a non-university hospital. The pathway reduced the number of biopsies and reliably detected the site of the most aggressive cancers.

Keywords: Algorithms; Biopsy; Magnetic resonance imaging; Patient care team; Prostate neoplasms.

MeSH terms

  • Hospitals
  • Humans
  • Image-Guided Biopsy
  • Magnetic Resonance Imaging
  • Magnetic Resonance Imaging, Interventional*
  • Male
  • Prostatic Neoplasms* / diagnostic imaging
  • Prostatic Neoplasms* / surgery
  • Retrospective Studies