Related Experiment Video
Updated: Sep 13, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Reevaluating prostate imaging-reporting and data system 3 lesions upgraded to 4: the emergence of a new subgroup?
Diğdem Kuru Öz1, Sezer Nil Yılmazer Zorlu2, Zeynep Eskalen3
1Department of Radiology, School of Medicine, Ankara University, 06230 Ankara, Turkey.
Objectives:
The study aims to evaluate Prostate Imaging-Reporting and Data System 4 (PI-RADS 4) lesions, including those with primary diffusion restriction (diffusion-weighted imaging score 4) and those upgraded from PI-RADS 3 due to positive dynamic contrast-enhanced findings, and to compare outcomes between these groups while also assessing cancer detection rates and prostatitis between upgraded cases and PI-RADS 3 lesions.
Methods:
In this single-center cohort study, peripheral zone lesions classified as PI-RADS 3 and 4 by multiparametric MRI and biopsied via MRI/transrectal ultrasound-guided targeted biopsy were analyzed.
Results:
Of 420 peripheral zone lesions from 272 patients, 202 were PI-RADS 3, 81 PI-RADS 3 + 1, and 137 PI-RADS 4. Cancer detection rates significantly differed between PI-RADS 3 + 1 and PI-RADS 4 (38.3% vs 73% for overall cancer; 6.2% vs 30.7% for clinically significant cancer, P < .001). PI-RADS 3 + 1 lesions had significantly higher cancer detection rates than PI-RADS 3 lesions (38.3% vs 19.8%, P = .001). Prostatitis was significantly more prevalent in PI-RADS 3 (34.7%) and PI-RADS 3 + 1 (29.6%) than in PI-RADS 4 (10.9%) lesions (P < .001).
Conclusions:
PI-RADS 3 + 1 lesions show significantly different cancer detection rates from both PI-RADS 3 and 4, suggesting they should be managed as a distinct entity. Higher prevalence of prostatitis in PI-RADS 3 + 1 lesions indicates that clinical evaluation for inflammatory conditions may help reduce unnecessary biopsies in this subgroup.
Advances In Knowledge:
PI-RADS 3 + 1 lesions show higher cancer detection than PI-RADS 3 but lower than PI-RADS 4, and are more frequently associated with prostatitis than PI-RADS 4. These findings support individualized management to avoid unnecessary biopsies.
