From the Guidelines
A Prostate Imaging-Reporting and Data System (PI-RADS) score of 4 indicates a high likelihood of clinically significant prostate cancer (csPCa) in the prostate.
Key Findings
- The likelihood of csPCa increases with the PI-RADS assessment category, with PI-RADS 4 having a higher likelihood than PI-RADS 3 but lower than PI-RADS 5 1.
- Studies have shown that the prevalence of csPCa (GS ≥ 3 + 4) in patients with PI-RADS 4 lesions ranges from 22% to 71% 1.
- A large retrospective analysis found that csPCa was detected in 67% of patients with PI-RADS 4 lesions 1.
- Another study found that the probability of cancer detection incrementally increased with the PI-RADS v2 category, with 71% probability for PI-RADS 4 lesions 1.
Implications
- A PI-RADS score of 4 should prompt further evaluation and consideration of biopsy to confirm the presence of csPCa.
- The use of PI-RADS v2 has been shown to have high performance in detecting prostate cancer, with a pooled sensitivity of 89% and specificity of 73% 1.
From the Research
Prostate Imaging-Reporting and Data System (PI-RADS) Score of 4
- A PI-RADS score of 4 indicates a high suspicion of prostate cancer, but the exact cancer detection rate varies across studies 2, 3, 4, 5, 6.
- According to a study published in 2016, a PI-RADS score of 4 had a cancer detection rate of 29.8% for all tumors and 21.3% for Gleason 3+4 or greater tumors 3.
- Another study from 2018 found that a PI-RADS v2 score of 4 or greater was associated with a higher percentage of clinically significant prostate cancer (90.86% vs. 55.88%, P < 0.001) 2.
- The combination of PI-RADS v2 score and prostate-specific antigen (PSA) density can help predict biopsy outcome in prostate biopsy naïve patients, with a PI-RADS v2 score of ≥4 and PSA density ≥0.15 ng/mL/mL associated with high clinically significant prostate cancer detection rates (76-97%) 6.
- A PI-RADS v2 score of 4 or greater was also found to be an independent predictor of clinically significant prostate cancer, along with age, PSA level, free/total PSA ratio, and PSA density 2.