ArticleResearch and reports in urology2025
Does Size Matter? A Retrospective Study Analysing the Size of PI-RADS 4 Lesions and Its Associated Prostate Cancer Positivity with Transperineal Prostate Biopsy.
Article in Research and reports in urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Comparison of MRI-guided in-bore and fusion biopsy for small PI-RADS 4 prostate lesions.World journal of urology · 2026Article
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10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Introduction: Magnetic resonance imaging (MRI) is an essential tool in Prostate Cancer (PCa) diagnosis. PI-RADS v2.1 score correlates with clinically significant prostate cancer (CSPCa) and according to the most recent guidelines, prevalence of CSPCa with PI-RADS 4 is 33-41%, while PI-RADS 5 is 62-79%. These groups are separated only by a size of 15 mm yet the difference in risk is significant. This study aims to find a size threshold associated with CSPCa within the PI-RADS 4 group, which may be used in combination with other prostatic parameters, such as PSA density in order to help with risk stratification and patient counselling in the pre-biopsy setting. This may also aid with surveillance of smaller PI-RADS 4 lesions in the setting of a negative biopsy and avoid unnecessary repeat biopsies unless triggered by a size threshold. Methods: A retrospective study was performed with data from 407 patients undergoing transperineal prostate biopsy (TPPB) between April 2022 and November 2023. A subgroup of patients with PI-RADS 4 was included for analysis. A ROC-AUC was obtained. Results: Median age was 67 (interquartile range: 61-71) and PSA density 0.20 (interquartile range 0.13-0.28). PI-RADS score correlated with CSPCa: for PI-RADS 1 and 2, the frequency of CSPCa was 10%; for PI-RADS 3, it was 20%; for PI-RADS 4, it was 60%; and for PI-RADS 5, it was 80%, Pearson correlation = 0.51, p < 0.001. The Receiver Operating Characteristic Area Under the Curve (ROC-AUC) was determined to be 0.664 [0.579-0.7499]. The optimal cut-off point was 8.5 mm. Patients with lesions larger than 8.5 mm had 2.31 times higher risk CSPCa. Conclusion: PI-RADS 4 size does matter and is a useful predictor of CSPCa. In our study, a cut-off of 8.5 mm was identified. The combination of PI-RADS 4 with PSA density provides a specificity higher than 80% for CSPCa detection.
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