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Updated: Oct 25, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Pathological features of Prostate Imaging Reporting and Data System (PI-RADS) 3 MRI lesions in biopsy and radical
Razvan-George Rahota1, Romain Diamand2, Bernard Malavaud3,4
1Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France.
Objective:
To assess the whole pathology spectrum of Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, identified on magnetic resonance imaging, using systematic (SB), targeted biopsy (TB) and radical prostatectomy (RP) specimen analysis.
Methods:
From a prospective database of patients undergoing RP after a combination of SB (median 12 cores) and fusion TB (median 3 cores), we included 150 PI-RADS 3 cases. Clinically significant prostate cancer (csPCa) was defined by a Grade Group 2 or more. The primary endpoints were unfavourable features in RP specimens.
Results:
Targeted biopsy was negative in 20.7% of patients. Final Grade Group 3 or more and a pT3 stage was reported in 36.7% and 38.7% of RP specimens. The upgrading rate was 38.2% between biopsy and RP specimens. The concordance rate between Grade Group on TB and RP was only 38.0%. The two independent predictive factors for unfavourable disease (pT3-4 and/or final Grade Group 3-5) were prostate-specific antigen density (PSAD; P = 0.001) and presence of csPCa on TB (odds ratio 3.7; P = 0.001). The risk of unfavourable disease was increased 2.3-fold and 5.8-fold, respectively, for patients with a PSAD between 0.15 and 0.20, and a PSAD >0.20 ng/mL/g. The 5-year biochemical recurrence-free survival rate was 93.2%.
Conclusions:
PI-RADS 3 lesions exhibited aggressive features in almost 40% of cases. PSAD and presence of csPCa on TB are independent predictive factors for high-grade and/or extraprostatic disease. A combination of SB and TB improve grade prediction compared to use of TB alone.
Insights
Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions on MRI can indicate aggressive prostate cancer. Prostate-specific antigen density and targeted biopsy results predict unfavorable disease, improving risk assessment when combined with systematic biopsy.
Area of Science:
- Urology
- Radiology
- Pathology
Background:
- Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions on MRI represent an intermediate category requiring careful evaluation.
- Understanding the full pathological spectrum of PI-RADS 3 lesions is crucial for appropriate patient management.
Purpose of the Study:
- To evaluate the pathology spectrum of PI-RADS 3 lesions identified by MRI.
- To compare diagnostic accuracy using systematic biopsy (SB), targeted biopsy (TB), and radical prostatectomy (RP) specimens.
Main Methods:
- Analysis of 150 PI-RADS 3 cases from a prospective database of patients undergoing radical prostatectomy.
- Inclusion of data from both systematic biopsy (median 12 cores) and fusion targeted biopsy (median 3 cores).
- Definition of clinically significant prostate cancer (csPCa) as Grade Group 2 or higher.
Main Results:
- Targeted biopsy was negative in 20.7% of cases.
- 36.7% of RP specimens showed Grade Group 3 or higher, and 38.7% showed pT3 stage.
- Upgrading occurred in 38.2% of cases between biopsy and RP; concordance rate between Grade Group on TB and RP was 38.0%.
Conclusions:
- PI-RADS 3 lesions can harbor aggressive prostate cancer in nearly 40% of cases.
- Prostate-specific antigen density (PSAD) and the presence of csPCa on TB are independent predictors of unfavorable disease.
- Combining SB and TB improves grade prediction compared to TB alone.
