Correlation of Multiparametric MRI PIRADS Scoring with Histopathological Outcomes and Prognostic Significance in Prostate Cancer: A Tertiary Care Center Study.

Abstract

The objective of this study was to investigate the correlation between Prostate Imaging Reporting and Data System (PIRADS) scores obtained from multiparametric magnetic resonance imaging (mpMRI) and histopathological outcomes, including Gleason grades and adverse prognostic factors, in patients undergoing prostate biopsy for suspected prostate cancer. This retrospective study included 195 patients who underwent mpMRI and transrectal ultrasound-guided biopsy. PIRADS scores were assigned based on the PIRADS v2.1 guidelines, and biopsy specimens were evaluated for clinically significant prostate cancer (CSPCa), defined as Gleason score ≥ 7, as well as for adverse features such as Extracapsular Extension (ECE), Lymphovascular invasion (LVI), and Perineural invasion (PNI). Diagnostic accuracy of PIRADS scores was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Among 195 patients who underwent biopsy, PIRADS 3 lesions had a PPV of 20.00% for CSPCa, with 42.86% negative biopsy results. PIRADS 4 and 5 lesions showed higher PPVs for CSPCa at 71.43% and 86.00%, respectively. The majority of patients with PIRADS 3 lesions had Gleason 6 cancers, while PIRADS 4 and 5 lesions were significantly associated with higher Gleason scores (≥ 7). PIRADS 5 lesions had the highest rates of adverse features, including ECE (38%), LVI (14%), and PNI (24%), compared to PIRADS 4 and 3 lesions. Diagnostic accuracy was highest for PIRADS 4-5 lesions, with a sensitivity of 78%, specificity of 75%, and area under the curve (AUC) of 0.82, while PIRADS 3 lesions had a lower sensitivity (24%) and AUC (0.65). Higher PIRADS scores are significantly associated with an increased Likelihood of CSPCa, more aggressive Gleason grades, and adverse pathological features. PIRADS 4-5 lesions demonstrate high diagnostic accuracy for CSPCa, supporting their use in guiding biopsy decisions and treatment planning. PIRADS 3 lesions, though less predictive, still warrant individualized management, with some cases presenting aggressive disease. These findings reinforce the clinical utility of PIRADS scoring in prostate cancer risk stratification.