@Article{,
AUTHOR = {Snir Dekalo, Ohad Mazliah, Eyal Barkai, Yuval Bar-Yosef, Haim Herzberg, Tomer Bashi, Ibrahim Fahoum, Sophie Barnes, Mario Sofer, Ofer Yossepowitch, Gal Keren-Paz, Roy Mano},
TITLE = {MRI-based PI-RADS score predicts ISUP upgrading and adverse pathology at radical prostatectomy in men with biopsy ISUP 1 prostate cancer},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {31},
YEAR = {2024},
NUMBER = {4},
PAGES = {11955--11962},
URL = {http://www.techscience.com/CJU/v31n4/59577},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> 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.<br/>
<b>Materials and methods:</b> 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.<br/>
<b>Results:</b> 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) .<br/>
<b>Conclusion:</b> 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.},
DOI = {}
}