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.

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.

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.

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.