Pi-Rads Classification

Are you concerned about the possibility of prostate cancer? Pi-Rads classification is a system used to evaluate MRI images of the prostate and determine the likelihood of prostate cancer. In this medical article, we will talk about Pi-Rads and what each Pi-Rads value means for your prostate cancer risk. Read on to learn more!

What is the Pi-Rads classification?

Pi-Rads classification is a system used to evaluate prostate MRI images. It was developed to improve the accuracy of prostate cancer diagnosis while reducing the number of unnecessary biopsies. The classification includes five levels, from Pi-Rads 1 (low risk for prostate cancer) to Pi-Rads 5 (high risk for prostate cancer). The classification is based on several factors, such as the size and location of changes in prostate tissue, the appearance of the tissues on the MRI image, and other clinical information. It is used by radiologists to determine the likelihood of prostate cancer and to plan further treatment. Unfortunately, the assignment of image changes to the particular score is subjective and has high variability depending on the examiner.

What does a Pi-Rads 5 lesion or Pi-Rads Score 5 mean?

PI-RADS Score 5: the presence of a clinically significant prostate carcinoma is very likely.

A Pi-Rads Score of 5 means that based on changes in the prostate tissue on the MRI image, it is very likely that the patient has prostate cancer. However, a Pi-Rads score of 5 does not mean that the patient definitely has prostate cancer, and it is recommended that a prostate biopsy be performed to confirm the diagnosis. The safest approach is to specifically biopsy the Pirads 5 lesion. At the ALTA clinic, the lesion is biopsied live on MRI. This allows precise control that the sample is taken exactly from the center of the suspicious area. This is the only way to determine the most accurate diagnosis.

What does a Pi-Rads 4 lesion or Pi-Rads Score 4 mean?

PI-RADS Score 4: the presence of clinically significant carcinoma is likely.

A Pi-Rads 4 lesion means that there are visible changes in the prostate tissue on MRI images that may be indicative of prostate cancer. However, unlike a Pi-Rads score of 5, a Pi-Rads score of 4 means that the risk for prostate cancer is slightly lower. Even with a Pi-Rads Score of 4, it is recommended that a biopsy of the prostate be performed to confirm the diagnosis and to plan for possible treatment.

What does a Pi-Rads 3 lesion or Pi-Rads Score 3 mean?

PI-RADS Score 3: the presence of clinically significant carcinoma is questionable (unclear findings).

Pi-Rads 3 lesions also show changes in the prostate tissue. Although the lesion is not as clear as in a PIRADS 4 or even 5, prostate carcinoma can still be detected on prostate biopsy. In most cases, a PI-RADS 3 lesion masks prostate inflammation. Nevertheless, in order not to miss a prostate cancer, a targeted biopsy is recommended in accordance with the S3 guideline since July 2021, even in the case of a PI-RADS 3 classification.

A 2015 study investigated whether prostate lesions characterized as PIRADS 3 were associated with a low probability of the presence of clinically significant prostate cancer. (doi: 10.1159/000365697)

Recent studies on Pi-Rads classification

A meta-analysis of 13 prospective studies involving over 4000 patients examined prostate cancer risk stratification by Pi-Rads version 2. Pooled detection rates for clinically significant prostate cancer increased monotonically for each Pi-Rads category, ranging from 4% in categories 1-2 to 75% in category 5. Considerable heterogeneity was found in clinically significant prostate cancer detection rates for pi wheels categories 1-2 and 4, which were significantly influenced by study participant selection and studies at high risk for bias. The conclusion of the study was that Pi-Rads v2 can be used to stratify the risk of clinically significant prostate cancer in patients at risk for prostate cancer, but limitations in category 4 remain. (doi: 10.1097/JU.0000000000001306)

Conclusion from the medical professional

Do you have an MRI of the prostate and want to know what the Pi-Rads classification means? Pi-Rads is a classification system that helps radiologists determine the likelihood of prostate cancer. It ranges from Pi-Rads 1 (low risk for prostate cancer) to Pi-Rads 5 (high risk for prostate cancer). A Pi-Rads 5 lesion or Pi-Rads Score 5 means that the presence of clinically significant carcinoma is very likely, and a Pi-Rads 4 lesion or Pi-Rads Score 4 means that the presence of clinically significant carcinoma is likely. Pi-Rads 3 lesions show changes in prostate tissue but are not as definitive as Pi-Rads 4 or Pi-Rads 5. Recent studies on Pi-Rads classification suggest that it can be used to stratify the risk of clinically significant prostate cancer, but the limitations with Pi-Rads category 4 remain. Ultimately, a biopsy is still required to confirm the diagnosis and plan treatment.