Pathologic Upgrading in Biopsy Grade Group 1, PI-RADS ≥ 3 Prostate Cancer: Factors Associated With Clinically...

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Active surveillance is standard for Gleason Grade Group 1 prostate cancer.
• Suspicious MRI findings (PI-RADS ≥ 3) in GG1 patients can indicate higher-grade disease.
• Accurate risk stratification is crucial for managing prostate cancer.

Purpose of the Study:

• Quantify pathologic upgrading rates in GG1/PI-RADS ≥ 3 prostate cancer patients undergoing surgery.
• Identify predictors of clinically significant cancer in this patient group.

Main Methods:

• Retrospective review of men undergoing transperineal MRI-ultrasound fusion biopsy.
• Analysis of patients with biopsy GG1 and PI-RADS ≥ 3, grouped by radical prostatectomy (RP) status.
• Multivariable Firth logistic regression to assess predictors of upgrading (GG ≥ 2).

Main Results:

• Of 244 eligible patients, 62 underwent RP.
• Pathologic upgrading to GG ≥ 2 occurred in 72.6% of RP patients.
• Smaller prostate volume and higher max systematic biopsy core involvement independently predicted upgrading.

Conclusions:

• Pathologic upgrading is frequent (73%) in biopsy GG1 men with PI-RADS ≥ 3 lesions.
• Biopsy risk classification has limitations for this subset.
• Prostate volume and tumor burden on systematic cores are key predictors for counseling and management.