Role of the Prostate Imaging Quality PI-QUAL Score for Prostate Magnetic Resonance Image Quality in Pathological Upstaging After Radical Prostatectomy: A Multicentre European Study

Increasing use of multiparametric magnetic resonance imaging (mpMRI) has come with heterogeneity in image quality. The Prostate Imaging Quality (PI-QUAL) score is under scrutiny to assess its usefulness in predicting clinical outcomes.To compare upstaging of localized disease on mpMRI (mrT2) to locally invasive disease in radical prostatectomy (RP) specimens (≥pT3a) in relation to PI-QUAL.Patients treated with RP between 2015 and 2020 who underwent 1.5-3-T mpMRI within 6 mo before surgery and had systematic and mpMRI-US targeted biopsies were included. mpMRI scans were retrospectively assigned a PI-QUAL score, and prospectively acquired Prostate Imaging-Recording and Data System (PI-RADS) scores (version 2.0 or 2.1) were used. PI-QUAL scores were categorized as nondiagnostic (PI-QUAL3), sufficient (PI-QUAL 3), or optimal (PI-QUAL3).We assessed the relationship between the PI-QUAL score and upstaging using multivariate logistic regression. mpMRI, clinical, and pathological findings were compared using χWe identified 351 patients, of whom 40 (11.4%) had PI-QUAL3, 57 (16.3%) had PI-QUAL 3, and 254 (72.3%) had PI-QUAL3 scores. The distribution of PI-QUAL3 (0-33.6%;In comparison to PI-QUAL ≥3, PI-QUAL3 was significantly associated with a higher rate of upstaging from organ-confined disease on mpMRI to locally advanced disease on pathology, lower detection rates for PI-RADS 5 lesions and extraprostatic extension, and a lower number of suspicious lesions.Poor image quality for magnetic resonance imaging (MRI) scans of the prostate is associated with underestimation of the stage of prostate cancer.