Prostate Imaging Reporting and Data System score of four or more: active surveillance no more.

Abstract

The introduction of multiparametric MRI (mpMRI) has improved the diagnosis and risk stratification of intermediate- and high-risk prostate cancer. In addition to diagnosis, mpMRI has increasingly become a useful tool for monitoring the prostate cancer risk of patients on active surveillance (AS) programmes. A significant proportion of men on AS programmes have suspicious lesions on mpMRI [1]. Accordingly, repeat mpMRI provides means of non-invasive assessment with the potential for fusion biopsy and preferential sampling of prostate cancer tissue. In 2012, the Prostate Imaging Reporting and Data System (PI-RADS) introduced standardised reporting of prostate mpMRI. PI-RADS 4 and 5 lesions have been classified as ‘clinically significant cancer is likely to be present’ and ‘clinically significant cancer is highly likely’, respectively. PI-RADS 4 and 5 lesions are being increasing correlated with intermediate- and high-grade prostate cancer. As recently discussed in Gleason pattern 4: active surveillance no more [2], patients with intermediate-risk prostate cancer are not suitable for AS. In light of this, the presence of PI-RADS 4 or 5 lesions in men enrolled on AS programmes for prostate cancer warrants concern.