PI-RADS Score Info Please

tonyqueue

Regular Member

Joined : Jun 2016

Posts : 58

Posted 8/15/2016 1:25 PM (GMT 0)

Hi Guys...Went for my biopsy today...Nowhere near as bad as I was expecting, 12 cores and only 2 of them were uncomfortable....Very nice Doc and Nurse...Was able to ask them a few questions, and even had a couple of laughs....Asked this doc about the PI-Rads Score (which I have since learned about)....Apparently my scan showed a PI-Rads score of 4.....Bummer!...I should have asked while I was in there, but although I knew this wasn't good didn't know the exact implications. Have now looked this up via Dr Google and it staes that a PI-RADS score of 4 means high likelihood of "clinically significant cancer"....My question is, what counts as "clinically significant"? does this just mean a malignancy of any kind? or does this mean a higher gleason grade?.....Don't want to scare myself, but at the same time I don't want to go in for my results completely naive.

Thanks in advance

Tony

Post Edited (tonyqueue) : 8/15/2016 8:11:01 AM (GMT-6)

Tall Allen

Elite Member

Joined : Jul 2012

Posts : 10645

Posted 8/15/2016 3:30 PM (GMT 0)

mpMRIs are really bad at detecting clinically insignificant prostate cancer, meaning cancers that are too small and too low grade to show up. So, say, a 3mm bit of GS6 probably wouldn't show up, but a 2 cm chunck of GS 9 probably would. But that doesn't mean that everything that does show up is cancer - a lot of lesions can show up that aren't cancer. Also remember that PIRADS scores are highly subjective and are only as good as the radiologist reading them. There is high inter-observer variability in assigning scores to lesions -- more experienced radiologists do better. The only way to know is with a biopsy.

- Allen

rockyfords

Regular Member

Joined : May 2016

Posts : 184

Posted 8/15/2016 3:33 PM (GMT 0)

Hi Tony- a quote from link below

"There is no universal definition for clinical significant prostate cancer, but the most frequent applied definition is the following: Pathology/histology with Gleason score ≥ 7 (including 3 + 4 with prominent but not predominant Gleason 4 component), and/or volume ≥ 0.5 cc, and/or extra prostatic extension (EPE) [6]. Depending on the Gleason score and clinical assessment of the patient’s disease, treatment options for prostate cancer are active surveillance, surgery and radiotherapy [7]."

/cancerimagingjournal.biomedcentral.com/articles/10.1186/s40644-016-0068-2

rf

sheepguy

Veteran Member

Joined : Nov 2010

Posts : 763

Posted 8/15/2016 4:02 PM (GMT 0)

Boy Howdy. PI- RADS indeed. I've personally known 4 guys at 3 different cancer centers get conflicting biopsy results from image guided and/ or fusion biopsies. All the way from PIRADS 5 being negative to no mpMRI findings gleason 8 on biopsy. Wilmot in Rochester, Upstate at Syracuse and MSK in NYC. I'm not doing the mMRI anytime soon since I can't travel to Houston or Chatanooga..where my uro says the best MRI "readers" are.

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