PI-RADS is a grading system used to interpret an MRI of the prostate to determine if you have prostate cancer or not.
There are grades 1 to 5, often reported as PI-RADS 1 to 5.
Developed by the European Society of Urogenital Radiology, PI-RADS is the short for Prostate Imaging Reporting and Data System.
With the availability of very high resolution MRIs referred to as 3-Tesla (3T) multiparametric MRIs, a number of things are looked for in an MRI image.
With a combination of these parameters, a PI-RADS score is then developed, which would help your doctor determine if you have a high likelihood of prostate cancer or not.
So, a 3T multiparametric MRI is able to take a look at the prostate gland in a 360 degree fashion, pick up abnormal cell types in the prostate and determine if this is cancer or not by comparing the characteristics of an abnormal area with normal prostate tissues.
Because an 3Tesla multiparametric MRI of the prostate does not just look at a shadow in the prostate gland alone, but also look at other parameters and behaviours of the abnormal area as discussed above, it has a very high sensitivity and specificity.
A TRUS biopsy is only reliable about 50 % of the time (TRUS biopsy is Trans Rectal Ultrasound guided biopsy of the prostate).
In comparison, an MRI of the prostate has over 90% reliability in the detection of prostate cancer. The combination of a positive PSA test (above expected range for your age), a high PSA velocity ( the rate of rise of your PSA over time) and a PI-RADs of 4 or more makes the presence of prostate cancer more likely in a patient. Even a Prostate Imaging Reporting and Data System score of 3 should trigger the possibility of an increased probability of prostate cancer, warranting periodic follow up and screening.
The general consensus among top urologists worldwide now is that a PI-RADS 4 or 5 is increasingly associated with the presence of an intermediate and high-grade prostate cancer.
The Gleason classification of prostate cancer assumes that a Gleason score of 6 or more suggests the presence of prostate cancer. A PI-RADS 4 or 5 is equivalent to a Gleason 7 or more.
A PI-RADS score of 4 or more is also now a trigger for definitive treatment for prostate cancer.
It means that if you have a Prostate Imaging – Reporting and Data System score of 4 or more, you are more likely to develop a metastatic cancer. Have you just had an MRI report showing a PI-RADS 4 or more, and have a positive PSA as well, the best approach would be to be seen by a urologist or interventional radiologist with experience in real-time MRI guided biopsy of the prostate.
This is different from the usual prostate biopsy that is done blindly and tumour cells or nodules are often missed. A biopsy if important to help get suspected abnormal cells and confirm the diagnosis by taking a look at the cells directly under the microscope.
Once this is done, the aggressiveness of the tumour or not could be established and the most appropriate treatment option adopted. Treatment for prostate cancer is increasingly getting better.
More options that ensure the preservation of the nerves around the organ and ensuring you retain erection and control of your urine are now available.
Do not think that having a PI-RADS 4 or more prostate MRI result automatically confines you to a life of impotence and leaking bladder. Speak with your doctor for a urologist consult immediately.