Related Experiment Video
Updated: Sep 26, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Prostate MRI percentage tumor involvement or "PI-RADS percent" as a predictor of adverse surgical pathology
Parita Ratnani1, Zach Dovey1, Sneha Parekh1
1Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Background:
This study assesses magnetic resonance imaging (MRI) prostate % tumor involvement or "PI-RADs percent" as a predictor of adverse pathology (AP) after surgery for localized prostate cancer (PCa). Two separate variables, "All PI-RADS percent" (APP) and "Highest PI-RADS percent" (HPP), are defined as the volume of All PI-RADS 3-5 score lesions on MRI and the volume of the Highest PI-RADS 3-5 score lesion each divided by TPV, respectively.
Method:
An analysis was done of an IRB approved prospective cohort of 557 patients with localized PCa who had targeted biopsy of MRI PIRADs 3-5 lesions followed by RARP from April 2015 to May 2020 performed by a single surgeon at a single center. AP was defined as ISUP GGG ≥3, pT stage ≥T3 and/or LNI. Univariate and multivariable analyses were used to evaluate APP and HPP at predicting AP with other clinical variables such as Age, PSA at surgery, Race, Biopsy GGG, mpMRI ECE and mpMRI SVI. Internal and External Validation demonstrated predicted probabilities versus observed probabilities.
Results:
AP was reported in 44.5% (n = 248) of patients. Multivariable regression showed both APP (odds ratio [OR]: 1.10, 95% confidence interval [CI]: 1.04-1.14, p = 0.0007) and HPP (OR: 1.10; 95% CI: 1.04-1.16; p = 0.0007) were significantly associated with AP with individual area under the operating curves (AUCs) of 0.6142 and 0.6229, respectively, and AUCs of 0.8129 and 0.8124 when incorporated in models including preoperative PSA and highest biopsy GGG.
Conclusions:
Increasing PI-RADS Percent was associated with a higher risk of AP, and both APP and HPP may have clinical utility as predictors of AP in GGG 1 and 2 patients being considered for AS.
Patient Summary:
Using PIRADs percent to predict AP for presurgical patients may help risk stratification, and for low and low volume intermediate risk patients, may influence treatment decisions.
Insights
Magnetic resonance imaging (MRI) prostate tumor involvement, or PI-RADS percent, predicts adverse pathology after prostate cancer surgery. Higher PI-RADS percent values indicate an increased risk of adverse pathology, aiding in treatment decisions.
Area of Science:
- Urology
- Radiology
- Oncology
Background:
- Adverse pathology (AP) after prostate cancer (PCa) surgery is a significant concern.
- Predicting AP preoperatively can guide treatment decisions and risk stratification.
Purpose of the Study:
- To evaluate the utility of magnetic resonance imaging (MRI) prostate tumor involvement, quantified as "PI-RADS percent" (APP and HPP), in predicting adverse pathology (AP) after radical prostatectomy for localized PCa.
Main Methods:
- A prospective cohort of 557 localized PCa patients undergoing MRI-targeted biopsy and radical prostatectomy (RARP) was analyzed.
- Adverse pathology was defined as ISUP Grade Group (GGG) ≥3, pT stage ≥T3, and/or lymph node involvement (LNI).
- Univariable and multivariable regression analyses assessed the association of "All PI-RADS percent" (APP) and "Highest PI-RADS percent" (HPP) with AP, controlling for clinical variables.
Main Results:
- Adverse pathology was identified in 44.5% of patients.
- Both APP and HPP were significantly associated with AP (OR: 1.10 for both; p < 0.001).
- When combined with preoperative PSA and highest biopsy GGG, models incorporating APP or HPP showed improved predictive accuracy (AUCs ~0.81).
Conclusions:
- Increasing PI-RADS percent is associated with a higher risk of adverse pathology in localized prostate cancer.
- APP and HPP demonstrate clinical utility in predicting AP, particularly for patients with GGG 1 and 2 considered for active surveillance.
- Preoperative PI-RADS percent assessment can aid in risk stratification and influence treatment decisions for localized PCa.
