MRI-based PI-RADS score predicts ISUP upgrading and adverse pathology at radical prostatectomy in men with biopsy ISUP 1 prostate cancer
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View abstract on PubMed
Summary
This summary is machine-generated.High PI-RADS 4 or 5 scores on multiparametric MRI (mpMRI) in men with low-risk prostate cancer strongly predict disease upgrading and adverse pathology. These findings suggest mpMRI should be integrated into active surveillance selection criteria.
Area Of Science
- Urology
- Radiology
- Oncology
Background
- Active surveillance is common for very-low and low-risk prostate cancer, but carries a risk of misclassification.
- Multiparametric MRI (mpMRI) is increasingly used to assess prostate cancer risk.
Purpose Of The Study
- To determine if PI-RADS 4 or 5 categories on mpMRI, combined with ISUP Grade 1 prostate cancer on biopsy, predict disease upgrading or adverse pathology at radical prostatectomy.
- To identify independent predictors of upgrading and adverse pathology in this patient cohort.
Main Methods
- A retrospective analysis of 127 patients with ISUP Grade 1 prostate cancer on biopsy after mpMRI who subsequently underwent radical prostatectomy.
- Evaluation for ISUP grade upgrading and adverse pathology (including extra-prostatic extension and positive surgical margins) on radical prostatectomy specimens.
Main Results
- Eighty-nine patients (70%) had PI-RADS 4 or 5 lesions. ISUP upgrading was significantly higher in patients with PI-RADS 4-5 lesions (84%) compared to those with equivocal or non-suspicious mpMRI (26%, p < 0.001).
- PI-RADS 4-5 lesions (OR 24.3) and DRE stage T2 (OR 5.9) were independent predictors of upgrading. Men with PI-RADS 4-5 lesions had higher rates of extra-prostatic extension (51% vs. 3%) and positive surgical margins (16% vs. 3%).
- PI-RADS 4-5 was the sole independent predictor of adverse pathology (OR 21.7).
Conclusions
- PI-RADS 4 or 5 lesions on mpMRI are strong independent predictors of both upgrading and adverse pathology in men with ISUP Grade 1 prostate cancer.
- These findings highlight the importance of incorporating mpMRI data into the decision-making process for active surveillance in prostate cancer.
- Further prospective studies are warranted to evaluate the precise role of mpMRI in refining active surveillance strategies.
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