PI-RADS V2 Improves Standardization of Prostate MRI Interpretation

New clinical imaging guidelines for the interpretation of prostate MRI exams have been released. A joint steering committee organized by the American College of Radiology, AdMeTech Foundation and European Society of Urogenital Radiology (ESUR) developed Prostate Imaging Reporting and Data System (PI-RADS) Version-2.

• PI-RADS is a standardized classification system for the interpretation of prostate MRI exams.
• Version 2 of PI-RADS attempts to improve prostate cancer detection and treatment recommendations.

PI-RADS was developed to aid in the early detection of and treatment recommendations for prostate cancer. Modeled after BI-RADS, guidelines used for interpreting mammograms, these new guidelines further standardize reporting for risk and location of aggressive prostate cancers.

The Need for Prostate Imaging Prior to Biopsy

Prostate cancer is a leading cause of death among men. However, prostate cancer patients have not had accurate diagnostic tools available to them. While tests like mammography have emerged to help screen for breast cancer and guide subsequent diagnostic exams, the prostate gland is randomly biopsied based on elevated levels of prostate-specific antigen (PSA).

This current standard of care has resulted in millions of inappropriate biopsies and inappropriate treatment recommendations. While more than one million biopsies are performed each year, only about one-third lead to prostate cancer diagnoses.

To complicate matters, not all prostate cancers are the same. Many low-grade cancers can remain untreated without causing harm for the rest of a man’s life. Blind biopsy often detects these cancers and can lead men to undergo unnecessary treatment. This can cause men to suffer side effects, like incontinence and/or impotence, without much benefit.

MRI has emerged as a viable option for imaging the prostate prior to biopsy. The development of specific imaging sequences now allows us to visualize the prostate gland in a non-invasive exam. Performing prostate MRI in men suspected of having prostate cancer could have many benefits.

• Triage men for biopsy, reducing the total number of biopsies performed.
• Reduce overdiagnosis of indolent cancers that do not require immediate treatment.
• Improve detection of high-risk, high-grade cancer by enabling targeted, image-guided biopsy.

“There is currently a steep learning curve for radiologists when it comes to interpreting MRI,” said RadNet Prostate MRI Medical co-Director Martin Cohen, M.D.  “For this reason, we recommend men seek exams that are performed with 3T MRI technology and interpreted by experienced prostate MRI readers. While prostate MRI is still growing, further fine tuning of PI-RADS should help to standardize interpretation and guide patient management.”

Prostate MRI is still being refined. While researchers have been investigating MRI of the prostate for more than two decades, recent advancements have allowed it to become a more effective diagnostic tool. In particular, the development of diffusion-weighted and dynamic contrast-enhanced imaging have enabled successful prostate MRI.

RadNet Prostate MRI Program Involvement in PI-RADS Development

Dr. Martin Cohen was among the members of the joint steering committee that developed PI-RADS Version 2. With professional interest in prostate MRI dating back to the early 1990s and more extensive experience in prostate MRI since 2009, Dr. Cohen was a strong addition to the expert group considering new standards.

In 2009, Dr. Cohen and RadNet Prostate MRI Medical co-Director Robert Princenthal, M.D., began working with vendors on the testing of prostate MRI hardware and software. This initial testing helped to validate prostate MRI as an effective imaging option for imaging the prostate. Dr. Cohen and Dr. Princenthal have since interpreted thousands of prostate MRI exams and helped to expand the RadNet Prostate MRI Program to seven centers in California. This makes RadNet one of the nation’s largest private radiology practices offering prostate MRI exams.

“The accomplishments made by the steering committee in the development of PI-RADS Version 2 should be encouraging to prostate cancer patients and physicians everywhere,” said Dr. Cohen. “We hope that these efforts help to achieve our common goal of improving prostate cancer detection and treatment.”

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