ISSN 2149-3235 | E-ISSN 2149-3057
Invited Review
Score 3 prostate lesions: a gray zone for PI-RADS v2
1 Department of Surgical and Biomedical Sciences, Division of Radiology 2, Perugia University, S.Maria Della Misericordia Hospital, S. Andrea Delle Fratte, Perugia, Italy  
2 Division of Urology, University Hospital, Modena, Italy  
3 Department of Experimental Medicine, Magrassi Lanzara, Second University of Naples, Italy  
Turk J Urol 2017; 43: 237-240
DOI: 10.5152/tud.2017.01058
Key Words: Lesion volume; magnetic resonance imaging; prostate cancer.

Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) does not offer a precise guidance on the clinical management (biopsy or not biopsy) for PI-RADS v2 score 3 lesions. Lesion volume calculated on biparametric MRI (bpMRI) [T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI)] by introducing a cut-off of 0.5 mL, allows to distinguish the lesions assigned by the multiparametric MRI (mpMRI) to the category PI-RADS v2 score 3 in two subgroups: a) Indolent or low risk lesions with volume <0.5 mL, and b) Significant or high risk lesions with volume ≥0.5 mL. For mpMRI lesions assigned to PI-RADS v2 score 3, we suggest the following management: 1) Subgroup a (low-risk lesion): Clinical surveillance (accurate evaluation of age and clinical informations, periodic monitoring of prostate specific antigen value and repeated bpMRI 1 year later); 2) Subgroup b (high-risk lesion): Targeted biopsy. The proposed management would reduce the use of unnecessary biopsies and increase the diagostic yield of significant prostate cancer of approximately 50% and 30% respectively. These approach encourage the radiologist to adopt MRI lesion volume to improve PI-RADS v2 and to optimize the management of PI-RADS v2 score 3 lesions.


Cite this article as: Scialpi M, Martorana E, Aisa MC, Rondoni V, D'Andrea A, Bianchi G. Score 3 prostate lesions: a gray zone for PI-RADS v2. Turk J Urol 2017; 43: 237-40

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