{"title":"Reevaluatıng Pı-rads 3 Lesıons Upgraded to 4: The Emergence of a New Subgroup?","authors":"Diğdem Kuru Öz, Sezer Nil Yılmazer Zorlu, Zeynep Eskalen, Nuray Haliloğlu, Ayşe Erden","doi":"10.1093/bjr/tqaf187","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>The study aims to evaluate PI-RADS 4 lesions, including those with primary diffusion restriction (diffusion-weighted imaging score 4) and those upgraded from PI-RADS 3 due to positive dynamic contrast-enhanced findings, and to compare outcomes between these groups while also assessing cancer detection rates and prostatitis between upgraded cases and PI-RADS 3 lesions.</p><p><strong>Methods: </strong>In this single-center cohort study, peripheral zone lesions classified as PI-RADS 3 and 4 by multiparametric magnetic resonance imaging (MRI) and biopsied via MRI/Transrectal ultrasound-guided targeted biopsy were analyzed.</p><p><strong>Results: </strong>Of 420 peripheral zone lesions from 272 patients, 202 were PI-RADS 3, 81 PI-RADS 3 + 1, and 137 PI-RADS 4. Cancer detection rates significantly differed between PI-RADS 3 + 1 and PI-RADS 4 (38.3% vs 73% for overall cancer; 6.2% vs 30.7% for clinically significant cancer, p < 0.001). PI-RADS 3 + 1 lesions had significantly higher cancer detection rates than PI-RADS 3 lesions (38.3% vs 19.8%, p = 0.001). Prostatitis was significantly more prevalent in PI-RADS 3 (34.7%) and PI-RADS 3 + 1 (29.6%) than in PI-RADS 4 (10.9%) lesions (p < 0.001).</p><p><strong>Conclusion: </strong>PI-RADS 3 + 1 lesions show significantly different cancer detection rates from both PI-RADS 3 and 4, suggesting they should be managed as a distinct entity. Higher prevalence of prostatitis in PI-RADS 3 + 1 lesions indicates that clinical evaluation for inflammatory conditions may help reduce unnecessary biopsies in this subgroup.</p><p><strong>Advances in knowledge: </strong>PI-RADS 3 + 1 lesions show higher cancer detection than PI-RADS 3 but lower than PI-RADS 4, and are more frequently associated with prostatitis than PI-RADS 4. These findings support individualized management to avoid unnecessary biopsies.</p>","PeriodicalId":9306,"journal":{"name":"British Journal of Radiology","volume":" ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/bjr/tqaf187","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: The study aims to evaluate PI-RADS 4 lesions, including those with primary diffusion restriction (diffusion-weighted imaging score 4) and those upgraded from PI-RADS 3 due to positive dynamic contrast-enhanced findings, and to compare outcomes between these groups while also assessing cancer detection rates and prostatitis between upgraded cases and PI-RADS 3 lesions.
Methods: In this single-center cohort study, peripheral zone lesions classified as PI-RADS 3 and 4 by multiparametric magnetic resonance imaging (MRI) and biopsied via MRI/Transrectal ultrasound-guided targeted biopsy were analyzed.
Results: Of 420 peripheral zone lesions from 272 patients, 202 were PI-RADS 3, 81 PI-RADS 3 + 1, and 137 PI-RADS 4. Cancer detection rates significantly differed between PI-RADS 3 + 1 and PI-RADS 4 (38.3% vs 73% for overall cancer; 6.2% vs 30.7% for clinically significant cancer, p < 0.001). PI-RADS 3 + 1 lesions had significantly higher cancer detection rates than PI-RADS 3 lesions (38.3% vs 19.8%, p = 0.001). Prostatitis was significantly more prevalent in PI-RADS 3 (34.7%) and PI-RADS 3 + 1 (29.6%) than in PI-RADS 4 (10.9%) lesions (p < 0.001).
Conclusion: PI-RADS 3 + 1 lesions show significantly different cancer detection rates from both PI-RADS 3 and 4, suggesting they should be managed as a distinct entity. Higher prevalence of prostatitis in PI-RADS 3 + 1 lesions indicates that clinical evaluation for inflammatory conditions may help reduce unnecessary biopsies in this subgroup.
Advances in knowledge: PI-RADS 3 + 1 lesions show higher cancer detection than PI-RADS 3 but lower than PI-RADS 4, and are more frequently associated with prostatitis than PI-RADS 4. These findings support individualized management to avoid unnecessary biopsies.
期刊介绍:
BJR is the international research journal of the British Institute of Radiology and is the oldest scientific journal in the field of radiology and related sciences.
Dating back to 1896, BJR’s history is radiology’s history, and the journal has featured some landmark papers such as the first description of Computed Tomography "Computerized transverse axial tomography" by Godfrey Hounsfield in 1973. A valuable historical resource, the complete BJR archive has been digitized from 1896.
Quick Facts:
- 2015 Impact Factor – 1.840
- Receipt to first decision – average of 6 weeks
- Acceptance to online publication – average of 3 weeks
- ISSN: 0007-1285
- eISSN: 1748-880X
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