Reliability of Prostate Imaging-Reporting and Data System (PIRADS) Scoring Following Holmium Laser Enucleation of Prostate (HoLEP).

Abstract

Objective: To determine whether prostate MRI PI-RADS scoring following HoLEP can reliably predict detection of prostate cancer on prostate biopsy.

Methods: Patients who underwent HoLEP followed by prostate MRI, targeted prostate biopsy, and systematic biopsy at a single institution from 2012 to 2024 were retrospectively reviewed. Patients were grouped based on highest PI-RADS score noted on prostate MRI. Patient demographics and clinical characteristics were gathered, and multivariate analyses were performed. Prevalence of prostate cancer detection based on PIRADS score were calculated. Locations of PIRADS lesions were also documented.

Results: 44 patients who underwent HoLEP followed by prostate MRI and targeted biopsy were included in our analysis. In post-HoLEP patients with PI-RADS lesions of 3, 4 or 5, clinically significant prostate cancer was detected in 66.7%, 59%, and 100% of patients on biopsy, respectively. 83% (n=5) of patients with PI-RADS 1-2 lesions were found to have clinically significant prostate cancer on systematic biopsy.

Conclusions: Prostate MRI and the PI-RADS system to detect prostate cancer does appear to have utility in patients that underwent HoLEP. A high proportion of patients with low PI-RADS scores were found to have clinically significant prostate cancer on systematic biopsy, however, therefore PI-RADS scoring alone should not impact a clinician's decision of whether to perform prostate biopsy. Additional characteristics such as PSA, PSA density or PSA kinetics should also be considered when determining when to perform prostate biopsy in post HoLEP patients.