Send to

Choose Destination
AJR Am J Roentgenol. 2017 Jul;209(1):W1-W9. doi: 10.2214/AJR.16.16981. Epub 2017 Apr 18.

PI-RADS Version 2: Detection of Clinically Significant Cancer in Patients With Biopsy Gleason Score 6 Prostate Cancer.

Author information

1 Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.
2 Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.
3 Department of Pathology, Hanyang University College of Medicine, Seoul, Republic of Korea.
4 Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea.



The purpose of this study was to analyze the utility of the Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) in the detection of a clinically significant cancers in patients with prostate cancers with a biopsy Gleason score of 6.


A group of 182 consecutively registered patients with biopsy-proven prostate cancer with a Gleason score of 6 underwent MRI and radical prostatectomy. Clinically significant cancer was surgically defined as Gleason score of 7 or greater, tumor volume of 0.5 cm3 or greater, or tumor category T3 or greater. Clinical parameters (prostate-specific antigen level, greatest percentage of biopsy core, and percentage of positive cores) and the PI-RADSv2 ratings by three independent readers (experienced readers 1 and 2, inexperienced reader 3) were investigated. Cutoffs and the diagnostic performance of PI-RADSv2 for clinically significant cancer were analyzed.


Clinically significant cancer was found in 87.4% (159/182) of patients. The cutoff PI-RADSv2 score for clinically significant cancer was 4 for readers 1 and 2 and 5 for reader 3. The AUCs were 0.829 and 0.853 for readers 1 and 2 (p < 0.001) and 0.602 for reader 3 (p = 0.067). For reader 1, sensitivity was 89.9% (143/159); specificity, 69.6% (16/23); positive predictive value, 95.3% (143/150); negative predictive value, 50.0% (16/32); and accuracy, 87.4% (159/182). The corresponding values for reader 2 were 81.1% (129/159), 82.6% (19/23), 97.0% (129/133), 38.8% (19/49), and 81.3% (148/182). For the experienced readers, 66.7-81.3% of patients with false-negative results had clinically significant cancers with tumor volume less than 1 cm3.


PI-RADSv2 may help experienced readers identify clinically significant prostate cancers in patients with a biopsy Gleason score of 6. However, some small (< 1 cm3) clinically significant cancers can be missed when PI-RADSv2 is used.


Gleason score; MRI; PI-RADS; clinically significant cancer; prostate cancer

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center