Applicability of PIRADs 2.1 scoring system to screen Prostate Cancer in a Ugandan population, a cross-sectional study.

Background/Objectives: Prostate Cancer (PCa) is highly prevalent in Africa. The Prostate Imaging Reporting and Data System (PIRADS) is used for detecting, staging, standardizing the acquisition, and reporting of BI-Parametric Magnetic Resonance Imaging (MRI) (Bp-MRI). The PIRADS is a “living” document and, through research, should be tested and validated for different healthcare settings. There is hardly any literature on the applicability and accuracy of the PIRADS 2.1 to screen for PCa in sub-Saharan Africa. The study sought to assess the applicability of the PIRADS 2.1 scoring system to screen PCa in sub-Saharan Africa. Methods: A retrospective review of imaging requisitions was done, including Bp-MRI, MRI reports, and histology reports, including the Gleason score, at an imaging institution in Uganda. The study assessed the ability of PIRADS alone, PIRADS and prostate specific antigen density (PSAD), PIRADS and Apparent Diffusion Coefficient (ADC), and PIRADS, PSAD, and ADC-combination to discriminate a positive histological prostate case. The study used the Area Under the Curve to determine the ability of PIRADS 2.1 to discriminate PCa. Results: The study reviewed 234 patient records, and of these, 99 were aged 65-74 years, and 48.7% were PCa histology-confirmed cases. PIRADS alone had an AUC 0.70, a combination of PIRADS V2.1 and PSAD had an AUC score 0.73, while a combination of PIRADS V2.1, PSAD, and ADC had an AUC 0.72. Conclusions: The accuracy of PIRADS for PCa discrimination is acceptable with an AUC 70%. Predominantly peripheral zone location, together with the low Gleason score and the background changes of chronic prostatitis, may account for the low PIRADS cancer prediction.