ArticleThe Prostate2026
Natural History of PI-RADS 3 Lesions on Serial Prostate mpMRI.
Article in The Prostate, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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14 authors.
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Abstract
objectivePI-RADS 3 lesions on prostate multiparametric MRI (mpMRI) are indeterminate findings with debated management. We evaluated their radiologic evolution on follow-up mpMRI and correlated imaging changes with biopsy outcomes.
methodsWe retrospectively identified 166 men with at least one PI-RADS 3 lesion on initial mpMRI and at least one follow-up mpMRI without intervening treatment. Lesions were classified at follow-up as regressed (downgraded to PI-RADS ≤ 2), stable (remained PI-RADS 3), or progressed (upgraded to PI-RADS 4-5). Lesions were stratified by zonal location. MRI-targeted biopsy results were reviewed when available (n = 64).
resultsOn follow-up, 52% of lesions regressed, 29% remained stable, and 19% progressed. Progression was significantly more common for peripheral-zone lesions (25%) than transition-zone lesions (6%); no central-zone lesions progressed. Of the biopsied lesions, most yielded benign or low-grade pathology: 44% were benign, 47% were ISUP 1, 6% had high-grade PIN or ASAP, and only 3% harbored clinically significant prostate cancer (csPCa; ISUP ≥ 2). Both csPCa cases occurred in lesions that had progressed radiologically. Lesions with imaging progression were significantly more likely to yield cancer on initial or follow-up biopsy than stable/regressed lesions (83% vs 40%; p = 0.037).
conclusionsIn this real-world cohort, most PI-RADS 3 lesions remained indolent: over half regressed, and 19% progressed. Biopsied lesions had a very low rate of csPCa (3%). These results suggest that surveillance with interval MRI rather than immediate biopsy may be a safe strategy for selected men with PI-RADS 3 lesions.
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