Observational studyEuropean radiology2023
Low cancer yield in PI-RADS 3 upgraded to 4 by dynamic contrast-enhanced MRI: is it time to reconsider scoring categorization?
Observational study in European radiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed.
- Artificial intelligence-assisted reading of non-contrast prostate MRI: application and concordance with expert interpretation in a screening population within the PROSA trial.European radiology · 2026Trial
- Design of a magnetic resonance imaging-based screening program for early diagnosis of prostate cancer: preliminary results of a randomized controlled trial-Prostate Cancer Secondary Screening in Sapienza (PROSA).European radiology · 2024Trial
- Contrast-free MRI-first screening in young asymptomatic men: Prostate characteristics and cancer detection rates.Prostate cancer and prostatic diseases · 2026Article
- Head-to-head comparison of MRI-based PI-RR scoring system and 68 Ga-PSMA-PET/CT: enhancing prostate cancer recurrence detection after radical prostatectomy.La Radiologia medica · 2026Article
- Integrating Artificial Intelligence into Prostate MR Imaging: Technical Foundations, Clinical Applications, and Workflow Implications.Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine · 2026Review
- PI-RADS v2.1 for prostate MRI: current applications, ongoing debates, and synergies with advanced technologies-a narrative review.Translational andrology and urology · 2026Review
- The evolving PI-RADS paradigm.Cancer imaging : the official publication of the International Cancer Imaging Society · 2026Review
- Clinical MR Biomarkers.Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer · 2026Review
- A multi-center study: development and validation of a BpMRI focused model in transition zone PI-RADS 3 and 4 lesions to detect clinically significant prostate cancer.Abdominal radiology (New York) · 2025Article
- Comparison of Biparametric MRI and Multiparametric MRI Using Split Dynamic MRI in Prostate Cancer Diagnosis.Journal of the Korean Society of Radiology · 2025Article
- Reevaluating prostate imaging-reporting and data system 3 lesions upgraded to 4: the emergence of a new subgroup?The British journal of radiology · 2025Article
- On-table monitoring of prostate MRI could enable tailored utilisation of gadolinium contrast.European radiology · 2025Observational
- Improving risk stratification of PI-RADS 3 + 1 lesions of the peripheral zone: expert lexicon of terms, multi-reader performance and contribution of artificial intelligence.Cancer imaging : the official publication of the International Cancer Imaging Society · 2025Article
- Evaluating Biparametric Versus Multiparametric Magnetic Resonance Imaging for Diagnosing Clinically Significant Prostate Cancer: An International, Paired, Noninferiority, Confirmatory Observer Study.European urology · 2025Article
- Does bladder outflow obstruction obfuscate the traditional clinical factors that are used to assess the risk of prostate cancer at rapid-access diagnostic clinics?BJUI compass · 2025Article
- Prospective evaluation of mpMRI-derived nomograms for detecting prostate cancer in PI-RADS v2.1 upgraded and non-upgraded lesions.Frontiers in oncology · 2025Article
- Performance of an ultra-fast deep-learning accelerated MRI screening protocol for prostate cancer compared to a standard multiparametric protocol.European radiology · 2024Article
- What the urologist needs to know before radical prostatectomy: MRI effective support to pre-surgery planning.La Radiologia medica · 2024Review
- Diagnostic performance of MRI in detecting prostate cancer in patients with prostate-specific antigen levels of 4-10 ng/mL: a systematic review and meta-analysis.Insights into imaging · 2024Article
- Interpreting Prostate MRI Reports in the Era of Increasing Prostate MRI Utilization: A Urologist's Perspective.Diagnostics (Basel, Switzerland) · 2024Review
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo evaluate MRI diagnostic performance in detecting clinically significant prostate cancer (csPCa) in peripheral-zone PI-RADS 4 lesions, comparing those with clearly restricted diffusion (DWI-score 4), and those with equivocal diffusion pattern (DWI-score 3) and positive dynamic contrast-enhanced (DCE) MRI.
methodsThis observational prospective study enrolled 389 men referred to MRI and, if positive (PI-RADS 3 with PSA-density [PSAD] ≥ 0.15 ng/mL/mL, 4 and 5), to MRI-directed biopsy. Lesions with DWI-score 3 and positive DCE were classified as "PI-RADS 3up," instead of PI-RADS 4. Univariable and multivariable analyses were implemented to determine features correlated to csPCa detection.
resultsPrevalence of csPCa was 14.5% and 53.3% in PI-RADS categories 3up and 4, respectively (p < 0.001). MRI showed a sensitivity of 100.0%, specificity 40.9%, PPV 46.5%, NPV 100.0%, and accuracy 60.9% for csPCa detection. Modifying the threshold to consider MRI positive and to indicate biopsy (same as previously described, but PI-RADS 3up only when associated with elevated PSAD), the sensitivity changed to 93.9%, specificity 57.2%, PPV 53.0%, NPV 94.8%, and accuracy 69.7%. Age (p < 0.001), PSAD (p < 0.001), positive DWI (p < 0.001), and PI-RADS score (p = 0.04) resulted in independent predictors of csPCa.
conclusionsMost cases of PI-RADS 3up were false-positives, suggesting that upgrading peripheral lesions with DWI-score 3 to PI-RADS 4 because of positive DCE has a detrimental effect on MRI accuracy, decreasing the true prevalence of csPCa in the PI-RADS 4 category. PI-RADS 3up should not be upgraded and directed to biopsy only if associated with increased PSAD. KEY POINTS: • As per PI-RADS v2.1 recommendations, in case of a peripheral zone lesion with equivocal diffusion-weighted imaging (DWI score 3), but positive dynamic contrast-enhanced (DCE) MRI, the overall PI-RADS score should be upgraded to 4. • The current PI-RADS recommendation of upgrading PI-RADS 3 lesions of the peripheral zone to PI-RADS 4 because of positive DCE decreased clinically significant prostate cancer detection rate in our series. • According to our results, the most accurate threshold for setting indication to prostate biopsy is PI-RADS 3 or PI-RADS 3 with positive DCE both associated with increased PSA density.
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