@Article{cju.2026.076673,
AUTHOR = {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},
TITLE = {Association of one single visible mpMRI PI-RADS index lesion with prostate cancer adverse pathology at robot-assisted radical prostatectomy: a 505-patient study},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {},
YEAR = {},
NUMBER = {},
PAGES = {{pages}},
URL = {http://www.techscience.com/CJU/online/detail/26957},
ISSN = {1488-5581},
ABSTRACT = { <b>Backgrounds:</b> 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. <b>Materials and methods:</b> 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. <b>Results:</b> 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; <i>p</i> &lt; 0.001) as those for 4 vs. 5 (OR = 0.404; 95% CI: 0.273–0.598; <i>p</i> &lt; 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; <i>p</i> &lt; 0.001) and the EAU intermediate one (OR = 0.171; 95% CI: 0.063–0.464; <i>p</i> &lt; 0.001). <b>Conclusions:</b> 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.},
DOI = {10.32604/cju.2026.076673}
}