Background: Prostate cancer is the second most prevalent cancer in men worldwide. It is the leading cause of cancer-related deaths in Africa, with higher incidence seen in sub-Saharan countries like Uganda. Currently, Prostate Imaging Reporting and Data System (PI-RADS) classification is the most sensitive imaging technique for diagnosing prostate cancer. There is limited literature on PI-RADS v 2.1 scoring system in the screening and diagnosis of prostate cancer in Uganda. Aim of the study: To describe the MRI findings and the correlations of PI-RADS v2.1 with prostatic specific antigen and histology Gleason scores among patients investigated for prostate cancer at Kampala MRI centre (KAMRIC). Methodology: This was a retrospective cross-sectional study that was conducted at KAMRIC. The prostate MRIs acquired using a 1.5 Tesla MRI scanner between March 2016 and December 2019, were included in the study. Blinded to the initial clinical and biopsy details, the PI, under the guidance of her supervisors, interpreted the prostate MRI images using PI-RADS v2.1. The results from the corresponding trans-rectal ultrasound-guided prostate biopsies were abstracted from the patients' records. Descriptive statistics on mpMRI were computed and correlations calculated for a subset of the images with available histology results. All statistical analyses were conducted using Stata version 15, p < 0.05. Results: A total of 189 MRI images of men with a mean age of 65 years (range, 41-89 years) were studied. The most common indication for MRI was raised serum PSA levels, the median for which was 8.5 ng/ml (95% CI 7.5-9.1). The median MRI prostate volume was 51.7 cubic centimetres (range 13.2-292.7; 95% CI 47.2-56.3). All the MRI images had an equal distribution of solitary and multiple lesions. Ninety-nine of the 131 (89%) images that scored PI-RADS 3-5 had corresponding ultrasound-guided biopsy results. Up to 52% (52/99) of all prostate biopsies were positive for adenocarcinoma. The median Gleason score was 7(3+4). Most MRI PI-RADS 3 lesions were negative for cancer. Similarly, PI-RADS 5 lesions (96%) were positive for cancer. A strong positive significant correlation (rs = 0.55 and rs = 0.53, respectively) between PI-RADS scores and histopathology was found. The correlation between PI-RADS and serum PSA levels was moderate (rs = 0.47, p < 0.05). Conclusion: PI-RADS v 2.1 scoring performs well in risk stratification and diagnosing clinically significant prostate cancer in this Ugandan cohort of adult male patients.

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