Correlation of PI-RADS Scores with TRUS-Guided Core Biopsy Findings in the Diagnosis of Prostate Cancer: A Retrospective–Prospective Observational Study

Background: Use of mpMRI with PI-RADS for risk assessment in the prostate cancer patient before biopsy is widely utilised. However, local clinicopathological correlation continues to remain important. The objective is to evaluate the association between PI-RADS category and TRUS-guided core-biopsy findings and assess the diagnostic performance of PI-RADS thresholds for clinically significant prostate cancer (csPCa). Material and Methods: This retrospective-prospective observational study was conducted in 120 male patients who underwent mpMRI followed by TRUS-guided core biopsy at ASCOMS, Sidhra, Jammu for two years. The collected data included age, PSA level, lesion size and location, PI-RADS score, biopsy findings, Gleason score, ISUP grade group, and clinically significant prostate cancer (csPCa) status. “Biopsy findings were correlated with PI-RADS categories using the chi-square test, whereas the relationship between PI-RADS categories and grade groups was analysed using Spearman rank correlation. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for PI-RADS cut-offs of ≥3 and ≥4. Results: Mean age was 67.4 ± 6.9 years and median PSA was 9.04 ng/mL (IQR 5.38–11.76). Cancer was identified on biopsy in 103 men (85.8%), and csPCa in 67 (55.8%). PI-RADS categories 2, 3, 4, and 5 were seen in 23, 18, 37, and 42 men, respectively. PI-RADS category had a significant association with biopsy diagnosis (P < 0.001) and grade group (Spearman ρ = 0.641; P < 0.001). For csPCa, PI-RADS ≥4 yielded sensitivity 91.0%, specificity 66.0%, PPV 77.2%, NPV 85.4%, and accuracy 80.0%, versus 98.5% and 41.5% for ≥3”. Conclusion: Higher PI-RADS categories were linked to malignant and clinically significant findings on biopsy. A PI-RADS threshold of ≥4 provided a more balanced diagnostic profile compared with a threshold of ≥3.

Keywords: PI-RADS; prostate carcinoma; mpMRI; TRUS-guided biopsy; ISUP grade group; diagnostic performance.