Molecular tumor profiling to identify mechanisms linking statins with lower risk of lethal prostate cancer

INTRODUCTION AND OBJECTIVES: Little data is available on the performance of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) on 3 Tesla multiparametric magnetic resonance imaging (mpMRI) in detecting prostate cancer (PCa) on definitive pathology after radical prostatectomy.In this study, we assessed the accuracy of PI-RADS v2 in detecting any PCa and clinically significant PCa (csPCa) on 3 Tesla mpMRI using whole-mount histology as the standard of reference.METHODS: Between May 2016 and February 2017 we prospectively enrolled patients with biopsy-proven PCa who underwent 3 Tesla mpMRI before radical prostatectomy.Three radiologists with 8, 7 and 2 years of mpMRI experience, who were blinded to final pathology, independently mapped and scored imaging findings according to PI-RADS v2 criteria.One experienced uropathologist processed prostate specimens using whole-mount protocol, and mapped all cancers according to the PI-RADS v2 39-sector scheme.Based on a lesion-bylesion mpMRI-to-whole-mount-pathology matching, we calculated sensitivity and specificity in detecting PCa and csPCa defined according to Epstein criteria, using PI-RADS 3 and 4 score as thresholds.We also assessed inter-reader agreement using Cohen 0 s weightedkappa statistic.RESULTS: Included were 48 patients (median age 68 years, median PSA 7.2 ng/ml) with 71 cancers on final histology (median size 16 mm, Gleason score 7 in 46 cases, stage pT3 in 22 cases).Lesions were in the peripheral zone, transition zone or both in 58, 9 and 4 cases, respectively.On a per-lesion basis, sensitivity was slightly higher with PI-RADS 3 vs. 4 threshold (range 0.55-0.62 vs. 0.48-0.60 for any PCa, and 0.67-0.74 vs. 0.61-0.72 for csPCa, respectively) at the expense of lower specificity (range 0.11-0.30vs. 0.56-0.71for any PCa, and 0.28-0.30vs. 0.55-0.71for csPCa, respectively).Accuracy improved on a per-patient basis, with 0.64-0.77sensitivity and 0.73-0.83specificity for csPCa with a PI-RADS 4 threshold.Inter-reader agreement was moderate to substantial (k¼0.47-0.72 vs. 0.51-0.71for PI-RADS thresholds 3 and 4, respectively).CONCLUSIONS: PI-RADS v2 showed good diagnostic performance in detecting csPCa, with acceptable inter-reader agreement.PI-RADS 4 threshold offered a better trade-off between sensitivity and specificity.