Long-term follow-up results of multiparametric prostate MRI and the prognostic value of PI-RADS: a single-center retrospective cohort study

PURPOSE We aim to examine the long-term outcomes of patients who underwent multiparametric prostate magnetic resonance imaging (mp-MRI) for suspected prostate cancer (PCa), specifically based on their initial Prostate Imaging Reporting and Data System (PI -RADS) categories and various clinical factors. Our secondary aim is to evaluate the prognostic value of the PI -RADS through the National Comprehensive Cancer Network (NCCN) risk group distribution. METHODS This research was conducted as a single -center retrospective cohort study in a tertiary care hospital. A total of 1,359 cases having at least one histopathological examination after the initial mp-MRI and/or adequate clinical/radiological follow-up data were included in the clinically significant PCa (cs-PCa) diagnosis -free survival analysis. Initial mp-MRI dates were accepted as the start of follow-up for the time -to -event analysis. The event was defined as cs-PCa diagnosis (International Society of Urological Pathology >= 2). Patients who were not diagnosed with cs-PCa during follow-up were censored according to predefined literature -based criteria at the end of the maximum follow-up duration with no reasonable suspicion of PCa and no biopsy indication. The impact of various factors on survival was assessed using a log -rank test and multivariable Cox regression. Subsequently, 394 cases diagnosed with PCa during follow-up were evaluated, based on initial PI -RADS categories and NCCN risk groups. RESULTS Three main risk factors for cs-PCa diagnosis during follow-up were an initial PI -RADS 5 category, initial PI -RADS 4 category, and high MRI-defined PSA density (mPSAD), with average hazard ratios of 29.52, 14.46, and 3.12, respectively. The PI -RADS 3 category, advanced age group, and biopsy -na & iuml;ve status were identified as additional risk factors (hazard ratios: 2.03, 1.54-1.98, and 1.79, respectively). In the PI -RADS 1-2 cohort, 1, 3, and 5 -year cs-PCa diagnosis -free survival rates were 99.1%, 96.5%, and 93.8%, respectively. For the PI -RADS 3 cohort, 1, 3, and 5 -year cs-PCa diagnosis -free survival rates were 94.9%, 90.9%, and 89.1%, respectively. For the PI -RADS 4 cohort, 1, 3, and 5 -year cs-PCa diagnosis -free survival rates were 56.6%, 55.1%, and 55.1%, respectively. These rates were found to all be 24.2% in the PI -RADS 5 cohort. Considering the 394 cases diagnosed with PCa during follow-up, PI -RADS >= 4 cases were more likely to harbor unfavorable PCa compared to PI -RADS <= 3 cases ( P < 0.001). In the PI -RADS 3 subgroup analysis, a low mPSAD (<0.15 ng/mL 2 ) was found to be a protective prognostic factor against unfavorable PCa ( P = 0.005). CONCLUSION The PI -RADS category has a significant impact on patient management and provides important diagnostic and prognostic information. Higher initial PI -RADS categories are associated with decreased follow-up losses, a shorter time to PCa diagnosis, increased biopsy rates, a higher likelihood of developing cs-PCa during follow-up, and a worse PCa prognosis. Combining mPSAD with PIRADS categories could enhance diagnostic stratification in the identification of cs-PCa.