Please don't give my opinion's any more weight than others -- I'd prefer you go to the sources and check me -- or anyone else -- out! I was referring to what I remembered about
these papers in the old Forum's subforum:MRI in early prostate cancer detection: how to manage indeterminate or equivocal PI-RADS 3 lesions?
(2018, Full Text)
This review focuses on indeterminate lesions on prostate MRI, assigned as PI-RADS category 3. We may conclude that the prevalence of PI-RADS 3 index lesion in the diagnostic work-up is significant, varying between one in three (32%) to one in five (22%) men, depending on patient cohort of first biopsies, previously negative biopsies, and active surveillance biopsies. Management strategies should be developed for this group of men with an indeterminate suspicion of having csPCa. Currently available data show that the actual prevalence of csPCa after targeted biopsy in PI-RADS 3 lesions varies between patients groups from one in five (21%) to one in six (16%), depending on previous biopsy status. Although this prevalence is lower in comparison to PI-RADS 4 and PI-RADS 5 lesions, still a considerable proportion of men harbor significant disease. Men with such a PI-RADS 3 lesion must therefore be adequately managed.
In general, the clinical approach of using a threshold of PI-RADS ≥4 instead of PI-RADS ≥3 to select MRI for targeted biopsies cannot be supported by data from our explorative literature search using the current definitions of csPCa. A possible adaptation to the threshold of PI-RADS ≥4 in combination with other clinical markers could be considered within an active surveillance protocol, where the balance between the individual risk of missing csPCa and the constant process of repeating prostate biopsies is crucial.
In addition to improvements in MR imaging, combinations with molecular biomarkers and multivariate risk models should be employed in prostate cancer detection and monitoring. These combinations will aid decision-making in challenging circumstances, such as unclear and diagnostic equivocal results for csPCa at early detection."
__________________________PIRADS 3 RADIOLOGIC “GREY ZONE” - WHAT PROPORTION OF MEN WHO HAVE PIRADS 3 LESIONS REPORTED ON MP-MRI HAVE PROSTATE CANCER?
It would seem prudent with our present knowledge to consider biopsy for all men with a PIRADS 3 report. The significance of gleason 3 + 4 disease on biopsy needs further assessment."
__________________________Which scores need a core? An evaluation of MR-targeted biopsy yield by PIRADS score across different biopsy indications
"Men who have had a previous negative biopsy had lower detection rates for any prostate cancer for PIRADS 3 and 4 lesions compared to those that were biopsy-naïve or on active surveillance. Conclusion: Cancer detection rates are significantly associated with PIRADS score. Biopsy yields differ across biopsy indications which should be considered when selecting a PIRADS score threshold for biopsy. Biopsy of PIRADS 3 lesions could potentially be avoided in men who have previously undergone a negative TRUS biopsy."
__________________________Prostate Imaging Reporting and Data System 3 Category Cases at Multiparametric Magnetic Resonance for Prostate Cancer: A Systematic Review and Meta-analysis
"Conclusions: In most investigations, PI-RADS 3 cases were not evaluated separately. A PI-RADS 3 lesion remains an equivocal lesion. Evaluation of clinical predictive factors in terms of csPC risk is a main aspect of helping clinicians in the biopsy decision process."
Post Edited (DjinTonic) : 6/21/2020 8:13:11 PM (GMT-6)