Skip to main content
SpringerLink
Log in

An MRI assessment of prostate cancer local recurrence using the PI-RR system: diagnostic accuracy, inter-observer reliability among readers with variable experience, and correlation with PSA values

  • Urogenital
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The Prostate Imaging for Recurrence Reporting (PI-RR) system has been recently proposed to promote standardisation in the MR assessment of prostate cancer (PCa) local recurrence after radical prostatectomy (RP) and radiation therapy (RT). This study aims to evaluate PI-RR’s diagnostic accuracy, assess the inter-observer reliability among readers with variable experience, and correlate imaging results with anatomopathological and laboratory parameters.

Methods

Patients who underwent a pelvic MRI for suspicion of PCa local recurrence after RP or RT were retrospectively enrolled (October 2017–February 2020). PI-RR scores were independently assessed for each patient by five readers with variable experience in prostate MRI (two senior and three junior radiologists). Biochemical data and histopathological features were collected. The reference standard was determined through biochemical, imaging, or histopathological follow-up data. Reader’s diagnostic performance was assessed using contingency tables. Cohen’s kappa coefficient (κ) and intraclass correlation coefficient (ICC) were calculated to measure inter-observer reliability.

Results

The final cohort included 120 patients (median age, 72 years [IQR, 62–82]). Recurrence was confirmed in 106 (88.3%) patients. Considering a PI-RR score ≥ 3 as positive for recurrence, minimum and maximum diagnostic values among the readers were as follows: sensitivity 79–86%; specificity 64–86%; positive predictive value 95–98%; negative predictive value 33–46%; accuracy 79–87%. Regardless of reader’s level of experience, the inter-observer reliability resulted good or excellent (κ ranges across all readers: 0.52–0.77), and ICC was 0.8. Prostate-specific antigen (PSA) velocity, baseline-PSA, and trigger-PSA resulted predictive of local recurrence at imaging.

Conclusions

The PI-RR system is an effective tool for MRI evaluation of PCa local recurrence and facilitates uniformity among radiologists.

Clinical relevance statement

This study confirmed the PI-RR system’s good diagnostic accuracy for the MRI evaluation of PCa local recurrences. It showed high reproducibility among readers with variable experience levels, validating it as a promising standardisation tool for assessing patients with biochemical recurrence.

Key Points

• In this retrospective study, the PI-RR system revealed promising diagnostic performances among five readers with different experience (sensitivity 79–86%; specificity 64–86%; accuracy 79–87%).

• The inter-observer reliability among the five readers resulted good or excellent (κ ranges: 0.52–0.77) with an intraclass correlation coefficient of 0.8.

• The PI-RR assessment score may facilitate standardisation and generalizability in the evaluation of prostate cancer local recurrence among radiologists.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

BCR:

Biochemical recurrence

CT:

Computed tomography

DCE:

Dynamic contrast enhancement

DWI:

Diffusion-weighted imaging

EAU:

European Association of Urology

GRE:

Gradient recalled echo

GS:

Gleason score

ICC:

Intraclass correlation coefficient

IQR:

Interquartile range

ISUP:

International Society of Urological Pathology

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PCa:

Prostate cancer

PET:

Positron emission tomography

PI-RADS:

Prostate Imaging-Reporting and Data System

PI-RR:

Prostate Imaging for Recurrence Reporting

PPV:

Positive predictive value

PSA:

Prostate-specific antigen

PSADT:

Prostate-specific antigen doubling time

PSAV:

Prostate-specific antigen velocity

PSMA:

Prostate-specific membrane antigen

RP:

Radical prostatectomy

RT:

Radiation therapy

SRT:

Salvage radiotherapy

T2WI:

T2-weighted imaging

TE:

Time of echo

TR:

Repetition time

TSE:

Turbo spin-echo

References

  1. Pernar CH, Ebot EM, Wilson KM, Mucci LA (2018) The epidemiology of prostate cancer. Cold Spring Harb Perspect Med 8:a030361. https://doi.org/10.1101/cshperspect.a030361

  2. Mottet N, van den Bergh RCN, Briers E et al (2021) EAU-EANM-ESTRO-ESUR-SIOG Guidelines on prostate cancer—2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 79:243–262. https://doi.org/10.1016/j.eururo.2020.09.042

    Article  CAS  PubMed  Google Scholar 

  3. Mottet N, Cornford P, van den Bergh RCN et al (2022) EAU guidelines: prostate cancer. Edn. presented at the EAU Annual Congress Amsterdam 2022. EAU Guidelines Office, Arnhem, The Netherlands. https://uroweb.org/guidelines/prostate-cancer. Accessed 13 Aug 2022

  4. Artibani W, Porcaro AB, De Marco V, Cerruto MA, Siracusano S (2018) Management of biochemical recurrence after primary curative treatment for prostate cancer: a review. Urol Int 100:251–262. https://doi.org/10.1159/000481438

    Article  CAS  PubMed  Google Scholar 

  5. Roach M, Hanks G, Thames H et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localised prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65:965–974. https://doi.org/10.1016/j.ijrobp.2006.04.029

    Article  PubMed  Google Scholar 

  6. Lowrance WT, Breau RH, Chou R et al (2021) Advanced prostate cancer: AUA/ASTRO/SUO guideline PART I. J Urol 205:14–21. https://doi.org/10.1097/JU.0000000000001375

    Article  PubMed  Google Scholar 

  7. Zaorsky NG, Calais J, Fanti S et al (2021) Salvage therapy for prostate cancer after radical prostatectomy. Nat Rev Urol 18:643–668. https://doi.org/10.1038/s41585-021-00497-7

    Article  PubMed  Google Scholar 

  8. Marra G, Valerio M, Emberton M et al (2019) Salvage local treatments after focal therapy for prostate cancer. Eur Urol Oncol 2:526–538. https://doi.org/10.1016/j.euo.2019.03.008

    Article  PubMed  Google Scholar 

  9. Cornford P, van den Bergh RCN, Briers E et al (2021) EAU-EANM-ESTRO-ESUR-SIOG Guidelines on prostate cancer. Part II—2020 update: treatment of relapsing and metastatic prostate cancer. Eur Urol 79:263–282. https://doi.org/10.1016/j.eururo.2020.09.046

    Article  CAS  PubMed  Google Scholar 

  10. Créhange G, Roach M, Martin É et al (2014) Salvage reirradiation for locoregional failure after radiation therapy for prostate cancer: who, when, where and how? Cancer Radiother 18:524–534. https://doi.org/10.1016/j.canrad.2014.07.153

    Article  PubMed  Google Scholar 

  11. De Visschere PJL, Standaert C, Fütterer JJ et al (2019) A systematic review on the role of imaging in early recurrent prostate cancer. Eur Urol Oncol 2:47–76. https://doi.org/10.1016/j.euo.2018.09.010

    Article  PubMed  Google Scholar 

  12. Parker C, Castro E, Fizazi K et al (2020) Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 31:1119–1134. https://doi.org/10.1016/j.annonc.2020.06.011

    Article  CAS  PubMed  Google Scholar 

  13. Das JP, Woo S (2022) Multiparametric prostate MRI for biochemical failure in the era of targeted PET radiotracers: point—MRI may no longer be needed in patient workup. AJR Am J Roentgenol 16:1–2. https://doi.org/10.2214/AJR.22.27882

    Article  Google Scholar 

  14. Pecoraro M, Panebianco V (2022) Multiparametric prostate MRI for biochemical failure in the era of targeted PET radiotracers: counterpoint—MRI remains a specific and accessible test for targeted management. AJR Am J Roentgenol 16:1–2. https://doi.org/10.2214/AJR.22.28042

    Article  Google Scholar 

  15. Van der Poel H, Grivas N, van Leeuwen P, Heijmink S, Schoots I (2019) The role of MRI for detection and staging of radio- and focal therapy-recurrent prostate cancer. World J Urol 37:1485–1490. https://doi.org/10.1007/s00345-019-02677-y

    Article  PubMed  Google Scholar 

  16. Potretzke TA, Froemming AT, Gupta RT (2020) Post-treatment prostate MRI. Abdom Radiol (NY) 45:2184–2197. https://doi.org/10.1007/s00261-019-02348-x

  17. Panebianco V, Barchetti F, Sciarra A et al (2013) Prostate cancer recurrence after radical prostatectomy: the role of 3-T diffusion imaging in multiparametric magnetic resonance imaging. Eur Radiol 23:1745–1752. https://doi.org/10.1007/s00330-013-2768-3

    Article  PubMed  Google Scholar 

  18. Linder B, Kawashima A, Woodrum D et al (2014) Early localisation of recurrent prostate cancer after prostatectomy by endorectal coil magnetic resonance imaging. Can J Urol 21:7283–7289

    PubMed  Google Scholar 

  19. Odisho AY, Washington SL, Meng MV, Cowan JE, Simko JP, Carroll PR (2013) Benign prostate glandular tissue at radical prostatectomy surgical margins. Urology 82:154–159. https://doi.org/10.1016/j.urology.2012.12.063

    Article  PubMed  Google Scholar 

  20. Burkhardt O, Neuenschwander JE, John H, Randazzo M (2018) Does seminal vesicle-sparing robotic radical prostatectomy influence postoperative prostate-specific antigen measured with an ultrasensitive immunoassay? Swiss Med Wkly 148:w14685. https://doi.org/10.4414/smw.2018.14685

  21. Panebianco V, Villeirs G, Weinreb JC et al (2021) Prostate Magnetic Resonance Imaging for Local Recurrence Reporting (PI-RR): international consensus -based guidelines on multiparametric magnetic resonance imaging for prostate cancer recurrence after radiation therapy and radical prostatectomy. Eur Urol Oncol 4:868–876. https://doi.org/10.1016/j.euo.2021.01.003

    Article  PubMed  Google Scholar 

  22. Pecoraro M, Turkbey BI, Purysko AS et al (2022) Diagnostic accuracy and observer agreement of the MRI Prostate Imaging for Recurrence Reporting assessment score. Radiology 304:342–350. https://doi.org/10.1148/radiol.212252

    Article  PubMed  Google Scholar 

  23. Pound CR, Partin AW, Eisenberger MA, Chan DW, Pearson JD, Walsh PC (1999) Natural history of progression after PSA elevation following radical prostatectomy. JAMA 281:1591. https://doi.org/10.1001/jama.281.17.1591

    Article  CAS  PubMed  Google Scholar 

  24. Vickers AJ, Brewster SF (2012) PSA velocity and doubling time in diagnosis and prognosis of prostate cancer. Br J Med Surg Urol 5:162–168. https://doi.org/10.1016/j.bjmsu.2011.08.006

    Article  PubMed  PubMed Central  Google Scholar 

  25. Connolly D, Black A, Murray LJ, Napolitano G, Gavin A, Keane PF (2007) Methods of calculating prostate-specific antigen velocity. Eur Urol 52:1044–1051. https://doi.org/10.1016/j.eururo.2006.12.017

    Article  CAS  PubMed  Google Scholar 

  26. Epstein JI, Egevad L, Amin MB et al (2016) The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 40:244–252. https://doi.org/10.1097/PAS.0000000000000530

    Article  PubMed  Google Scholar 

  27. Mottet N, Bellmunt J, Bolla M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71:618–629. https://doi.org/10.1016/j.eururo.2016.08.003

    Article  PubMed  Google Scholar 

  28. Van den Broeck T, van den Bergh RCN, Arfi N et al (2019) Prognostic value of biochemical recurrence following treatment with curative intent for prostate cancer: a systematic review. Eur Urol 75:967–987. https://doi.org/10.1016/j.eururo.2018.10.011

    Article  PubMed  Google Scholar 

  29. Tilki D, Preisser F, Graefen M et al (2019) External Validation of the European Association of Urology Biochemical Recurrence risk groups to predict metastasis and mortality after radical prostatectomy in a European cohort. Eur Urol 75:896–900. https://doi.org/10.1016/j.eururo.2019.03.016

    Article  PubMed  Google Scholar 

  30. Panebianco V, Turkbey B (2023) Magnetic resonance imaging for prostate cancer recurrence: it’s time for precision diagnostic with Prostate Imaging for Recurrence Reporting (PI-RR) score. Eur Radiol 33:748–751. https://doi.org/10.1007/s00330-022-09095-6

    Article  PubMed  Google Scholar 

  31. Kitajima K, Hartman RP, Froemming AT, Hagen CE, Takahashi N, Kawashima A (2015) Detection of local recurrence of prostate cancer after radical prostatectomy using endorectal coil MRI at 3 T: addition of DWI and dynamic contrast enhancement to T2-weighted MRI. AJR Am J Roentgenol 205:807–816. https://doi.org/10.2214/AJR.14.14275

    Article  PubMed  Google Scholar 

  32. Sandgren K, Westerlinck P, Jonsson JH et al (2019) Imaging for the detection of locoregional recurrences in biochemical progression after radical prostatectomy—a systematic review. Eur Urol Focus 5:550–560. https://doi.org/10.1016/j.euf.2017.11.001

    Article  PubMed  Google Scholar 

  33. Haider MA, Chung P, Sweet J et al (2008) Dynamic contrast-enhanced magnetic resonance imaging for localisation of recurrent prostate cancer after external beam radiotherapy. Int J Radiat Oncol Biol Phys 70:425–430. https://doi.org/10.1016/j.ijrobp.2007.06.029

    Article  PubMed  Google Scholar 

  34. Kim CK, Park BK, Park W, Kim SS (2010) Prostate MR imaging at 3T using a phased-arrayed coil in predicting locally recurrent prostate cancer after radiation therapy: preliminary experience. Abdom Imaging 35:246–252. https://doi.org/10.1007/s00261-008-9495-2

    Article  PubMed  Google Scholar 

  35. Turkbey B, Rosenkrantz AB, Haider MA et al (2019) Prostate Imaging Reporting and Data System version 2.1: 2019 update of Prostate Imaging Reporting and Data System version 2. Eur Urol 76:340–351. https://doi.org/10.1016/j.eururo.2019.02.033

    Article  PubMed  Google Scholar 

  36. Morash C (2021) What do you do with PI-RADS-3? Can Urol Assoc J 15:122. https://doi.org/10.5489/cuaj.7262

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kaps B, Leapman M, An Y (2020) Trends in prostatectomy utilization: increasing upfront prostatectomy and postprostatectomy radiotherapy for high-risk prostate cancer. Cancer Med 9:8754–8764. https://doi.org/10.1002/cam4.3482

    Article  PubMed  PubMed Central  Google Scholar 

  38. Cooperberg MR, Carroll PR (2015) Trends in Management for patients with localised prostate cancer, 1990–2013. JAMA 314:80. https://doi.org/10.1001/jama.2015.6036

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Hospital Universitario de Vigo, Carretera Clara Campoamor 341, 36312, Vigo, Spain

    Paolo Niccolò Franco, Sofia Frade-Santos, Alejandra García-Baizán, Laura Paredes-Velázquez & María Milagros Otero-García

  2. School of Medicine, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126, Milan, Italy

    Paolo Niccolò Franco & Sandro Sironi

  3. Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal

    Sofia Frade-Santos

  4. Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain

    María Aymerich & María Milagros Otero-García

  5. Department of Radiology, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127, Bergamo, Italy

    Sandro Sironi

Authors
  1. Paolo Niccolò Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sofia Frade-Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alejandra García-Baizán
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura Paredes-Velázquez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. María Aymerich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sandro Sironi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. María Milagros Otero-García
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paolo Niccolò Franco.

Ethics declarations

Guarantor

The scientific guarantor of this publication is María Milagros Otero-García.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors, María Aymerich (Institution: Diagnostic Imaging Research Group, Radiology Department, Galicia Sur Health Research Institute, SERGAS-UVIGO), is an expert in statistics/biometry.

Informed consent

The need for individual consent was waived by the Committee due to the retrospective nature of the study and according to local regulation.

Ethical approval

Institutional Review Board approval was obtained (identification no. 2022/239).

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported.

Methodology

• Retrospective

• Observational

• Performed at one institution

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 75 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Franco, P.N., Frade-Santos, S., García-Baizán, A. et al. An MRI assessment of prostate cancer local recurrence using the PI-RR system: diagnostic accuracy, inter-observer reliability among readers with variable experience, and correlation with PSA values. Eur Radiol 34, 1790–1803 (2024). https://doi.org/10.1007/s00330-023-09949-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-023-09949-7

Keywords

Search

Navigation