Reliability of Prostate Imaging-reporting and Data System Scoring Following Holmium Laser Enucleation of Prostate.

[OBJECTIVE] To determine whether prostate magnetic resonance imaging (MRI) prostate imaging reporting and data system (PI-RADS) scoring following holmium laser enucleation of the prostate (HoLEP) can reliably predict the detection of prostate cancer on prostate biopsy.

[METHODS] Patients who underwent HoLEP followed by prostate MRI, targeted prostate biopsy, and systematic biopsy at a single institution from 2012 to 2024 were retrospectively reviewed. Patients were grouped based on highest PI-RADS score noted on prostate MRI. Patient demographics and clinical characteristics were gathered, and multivariate analyses were performed. Prevalence of prostate cancer detection based on PI-RADS score was calculated. Locations of PI-RADS lesions were also documented.

[RESULTS] Forty-four patients who underwent HoLEP followed by prostate MRI and targeted biopsy were included in our analysis. In post-HoLEP patients with PI-RADS lesions of 3, 4 or 5, clinically significant prostate cancer was detected in 66.7%, 59%, and 100% of patients on biopsy, respectively. 83% (n=5) of patients with PI-RADS 1-2 lesions were found to have clinically significant prostate cancer on systematic biopsy.

[CONCLUSION] Prostate MRI and the PI-RADS system to detect prostate cancer appear to have utility in patients that underwent HoLEP. A high proportion of patients with low PI-RADS scores were found to have clinically significant prostate cancer on systematic biopsy, however, therefore, PI-RADS scoring alone should not impact a clinician's decision of whether to perform prostate biopsy. Additional characteristics such as PSA, PSA density, or PSA kinetics should also be considered when determining when to perform prostate biopsy in post-HoLEP patients.