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ARTICLE
Association of one single visible mpMRI PI-RADS index lesion with prostate cancer adverse pathology at robot-assisted radical prostatectomy: a 505-patient study
Antonio Benito Porcaro, Maria Angela Cerruto, Riccardo Bertolo*, Michele Boldini, Alessandro Veccia, Riccardo Rizzetto, Francesco Artoni, Andrea Franceschini, Alberto Baielli, Francesca Montanaro, Sonia Costantino, Matteo Brunelli, Salvatore Siracusano, Alessandro Antonelli
Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona and University of Verona, Piazzale Aristide Stefani 1, Verona, Italy
* Corresponding Author: Riccardo Bertolo. Email: 
Canadian Journal of Urology https://doi.org/10.32604/cju.2026.076673
Received 24 November 2025; Accepted 13 April 2026; Published online 25 May 2026
Abstract
Backgrounds: Multiparametric MRI (mpMRI) and the PI-RADS scoring system play a central role in the detection and risk stratification of prostate cancer; however, the prognostic significance of a single visible index lesion remains incompletely defined. The aim of the study was to evaluate associations of one single visible PI-RADS (Prostate Imaging–Reporting and Data System) index lesion varying from 3 to 5 with adverse pathology after robotic surgery and with clinical prostate cancer (PCa) including EAU (European Association of Urology) prognostic risk classes. Materials and methods: The study included only cases with one single visible PI-RADS lesion which varied from 3 to 5 with MRI procedures performed by dedicated radiologists. EAU prognostic risk classes were classified according to standard clinical parameter including PSA (Prostate-Specific Antigen), ISUP (International Society of Urological Pathology), percentage of biopsy positive cores, cTNM system. Adverse pathology was defined as any of the following at final specimen: ISUP grade group 4–5, extracapsular extension, seminal vesicle invasion, positive surgical margins, pelvic lymph node invasion. Analysis was carried out by the multinomial logistic regression model including PI-RADS lesions 3, 4, 5 as outcomes predicted by adverse pathology and EAU prognostic risk classes. Results: From January 2014 to December 2021, the study selected 505 patients who presented with one single visible PI-RADS index lesion varying from 3 (11.5%) to 4 (54.9%) up to 5 (33.7%); accordingly, adverse pathology, which was detected in 46.5% of specimens, was less likely to occur for index scores 3 vs. 5 (OR (Odds Ratio) = 0.272, 95% CI (Confidence Interval): 0.144–0.514; p < 0.001) as those for 4 vs. 5 (OR = 0.404; 95% CI: 0.273–0.598; p < 0.001); likewise, after adjusting for EAU risk classes, PI-RADS scores 3 vs. 5 were less likely to belong to the high risk class when compared with both the EAU low (OR = 0.092; 95% CI: 0.032–0.268; p < 0.001) and the EAU intermediate one (OR = 0.171; 95% CI: 0.063–0.464; p < 0.001). Conclusions: Single visible PI-RADS index lesions varying from 3 to 5 associated with both adverse pathology and unfavorable EAU prognostic risk classes; accordingly, they may allow stratification of patients while associating with adverse cancer biology.
Keywords
prostate cancer; multiparametric magnetic resonance imaging; prostate imaging-reporting and data system; prostate biopsy; radical prostatectomy; prognostic risk groups
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