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Retrospective analysis of the development of PIRADS 3 lesions over time: when is a follow-up MRI reasonable?

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Abstract

Purpose

Often PIRADS 3 findings are usually followed up with further MRIs of the prostate. Current guidelines do not state an optimal interval between the initial MRI and the follow-up MRI. The aim of this study was to find out if PIRADS 3 lesions evolve over time and to determine how long the optimal interval between initial MRI and follow-ups should be.

Methods

In this retrospective study, 141 consecutive patients were included who underwent at least one follow-up MRI after an initial PIRADS 3 finding. Changes in PIRADS score and the interval between the first and the follow-up MRI were recorded. An optimal duration was calculated.

Results

Of all patients, 76.6% had a change from PIRADS 3 to either 2 or 4 in the first follow-up MRI. Reclassifications to PIRADS 4 happened earlier than reclassifications to PIRADS 2 (after 366.5 ± 217.9 days and after 534.2 ± 253.0 days, respectively). An optimal point of time for a follow-up to distinguish between changes to PIRADS 2 versus PIRADS 4 turned out to be 379 days (12.4 months, AUC 0.734, p = 0.0001). Of all patients with a PIRADS 3 lesion 14.8% harboured a prostate carcinoma.

Conclusion

Performing follow-up mpMRI rather than immediate biopsy may be beneficial for patients with PIRADS 3, as most lesions can be reclassified after a manageable period of time. Upgrades to PIRADS 4 seem to happen earlier and within fewer follow-ups than downgrades to PIRADS 2. The optimal interval for follow-up MRIs seems to be 12.4 months.

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Authors and Affiliations

  1. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria

    Fabian Steinkohl, Leonhard Gruber & Friedrich Aigner

  2. Department of Urology, Medical University of Innsbruck, Innsbruck, Austria

    Jasmin Bektic

  3. Department of Urology, Landeskrankenhaus Hall in Tirol, Hall in Tirol, Austria

    Udo Nagele

  4. Department of Urology, Hannover Medical School, Hannover, Germany

    Thomas R. W. Herrmann

  5. Department of Urology, Kantonspital Thurgau, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  6. Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria

    Udo Nagele, Thomas R. W. Herrmann & Daniel Junker

  7. Department of Radiology, Landeskrankenhaus Hall in Tirol, Milser Straße 10, 6060, Hall in Tirol, Austria

    Michael Rieger & Daniel Junker

Authors
  1. Fabian Steinkohl
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  2. Leonhard Gruber
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  3. Jasmin Bektic
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  4. Udo Nagele
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  5. Friedrich Aigner
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  6. Thomas R. W. Herrmann
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  7. Michael Rieger
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  8. Daniel Junker
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Contributions

FS: data collection, manuscript writing and editing, data analysis. LG: data analysis, manuscript editing. JB: data collection, data management. UN: manuscript writing and editing, interpretation of data. FA: project development, data collection, critical revision of the manuscript. TRWH: manuscript editing, interpretation of data. MR: manuscript writing, critical revision of the manuscript. DJ: protocol and project development, manuscript writing.

Corresponding author

Correspondence to Daniel Junker.

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Conflict of interest

The authors declare that they have no conflict of interest, nothing to declare.

Research including human participants and ethical approval

This is a retrospective study. Institutional review board approval was granted by means of a general waiver for studies with retrospective data analysis (Ethikkommission, Med. Univ. Innsbruck; 2009-02-20). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Steinkohl, F., Gruber, L., Bektic, J. et al. Retrospective analysis of the development of PIRADS 3 lesions over time: when is a follow-up MRI reasonable?. World J Urol 36, 367–373 (2018). https://doi.org/10.1007/s00345-017-2135-0

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  • DOI: https://doi.org/10.1007/s00345-017-2135-0

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