Open Access

ARTICLE

MRI-based PI-RADS score predicts ISUP upgrading and adverse pathology at radical prostatectomy in men with biopsy ISUP 1 prostate cancer

Snir Dekalo^1,2, Ohad Mazliah², Eyal Barkai^1,2, Yuval Bar-Yosef^1,2, Haim Herzberg^1,2, Tomer Bashi^1,2, Ibrahim Fahoum^2,3, Sophie Barnes^2,4, Mario Sofer^1,2, Ofer Yossepowitch^1,2, Gal Keren-Paz^1,2, Roy Mano^1,2

1 Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
2 Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
3 Department of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
4 Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Address correspondence to Dr. Snir Dekalo, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906 Israel

Canadian Journal of Urology 2024, 31(4), 11955-11962.

Abstract

Introduction: Most men diagnosed with very-low and low-risk prostate cancer are candidates for active surveillance; however, there is still a misclassification risk. We examined whether PI-RADS category 4 or 5 combined with ISUP 1 on prostate biopsy predicts upgrading and/ or adverse pathology at radical prostatectomy.
Materials and methods: A total of 127 patients had ISUP 1 cancer on biopsy after multiparametric MRI (mpMRI) and then underwent radical prostatectomy. We then evaluated them for ISUP upgrading and/or adverse pathology on radical prostatectomy.
Results: Eight-nine patients (70%) were diagnosed with PI-RADS 4 or 5 lesions. ISUP upgrading was significantly higher among patients with PI-RADS 4-5 lesions (84%) compared to patients with equivocal or non-suspicious mpMRI findings (26%, p < 0.001). Both PI-RADS 4-5 lesions (OR 24.3, 95% CI 7.3, 80.5, p < 0.001) and stage T2 on DRE (OR 5.9, 95% CI 1.2, 29.4, p = 0.03) were independent predictors of upgrading on multivariate logistic regression analysis. Men with PI-RADS 4-5 lesions also had significantly more extra prostatic extension (51% vs. 3%, p < 0.001) and positive surgical margins (16% vs. 3%. p = 0.03). The only independent predictor of adverse pathology was PI-RADS 4-5 (OR 21.7, 95% CI 4.8, 99, p < 0.001) .
Conclusion: PI-RADS 4 or 5 lesions on mpMRI were strong independent predictors of upgrading and adverse pathology. Incorporating mpMRI findings when selecting patients for active surveillance must be further evaluated in future studies.

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