Turkish Journal of Urology
Invited Review

Score 3 prostate lesions: a gray zone for PI-RADS v2


Department of Surgical and Biomedical Sciences, Division of Radiology 2, Perugia University, S.Maria Della Misericordia Hospital, S. Andrea Delle Fratte, Perugia, Italy


Division of Urology, University Hospital, Modena, Italy


Department of Experimental Medicine, Magrassi Lanzara, Second University of Naples, Italy

Turk J Urol 2017; 43: 237-240
DOI: 10.5152/tud.2017.01058
Read: 1489 Downloads: 880 Published: 25 July 2019


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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