Although prostate magnetic resonance imaging (MRI) enhances the detection of high-grade prostate cancer (PCa), its predictive role in active surveillance (AS) of favorable risk PCa is unclear. We examined the association between baseline MRI Prostate Imaging-Reporting and Data System (PI-RADS) score and Gleason Grade Group (GG) upgrade risk among patients managed with AS.
We systematically searched eight databases to identify studies evaluating the association between baseline PI-RADS score and the risk of GG upgrade in patients managed with AS for PCa (PROSPERO: CRD42024567762). We pooled the hazard ratios (HR)using Hartung-Knapp random-effects meta-analysis models. We assessed the risk of bias using the ROBINS-I tool.
We included eleven studies (n = 6309) in the meta-analysis. The risk of bias was moderate, attributed to the retrospective and unblinded design of seven included studies. Among studies reporting baseline PI-RADS, 2,640 patients (52.1%) had PI-RADS 1-3 lesions, and 2,421 patients (47.9%) had PI-RADS 4-5 lesions. Baseline PI-RADS 4-5 was associated with an increased risk of upgrade compared to those with PI-RADS 1-3 lesions (HR:2.21, 95%CI: 1.66-2.93, p<.001). Compared to PI-RADS 1-2, the presence of PI-RADS 3 (HR:1.88, 95%CI: 1.29-2.74, p=.008), PI-RADS 4 (HR:2.73, 95%CI: 2.08-3.58, p<.001), or PI-RADS 5 (HR:3.69, 95%CI: 2.50-5.45, p<.001) lesions were associated with an increased risk of upgrade.
Baseline prostate MRI finding as assessed with PI-RADS is highly prognostic for GG upgrading among patients with favorable risk PCa managed with AS. These findings support further study of tailored surveillance strategies based on initial MRI findings.
World journal of urology. 2026 Feb 15*** epublish ***
Shayan Smani, Nishan Sohoni, Marcin Miszczyk, Tamás Fazekas, Pawel Rajwa, Alyssa A Grimshaw, Vinaik M Sundaresan, Soum D Lokeshwar, Jeffrey Weinreb, Preston C Sprenkle, Matthew R Cooperberg, Tyler M Seibert, Shahrokh F Shariat, William J Catalona, Michael S Leapman
Yale School of Medicine, New Haven, CT, USA., Medical University of Vienna, Vienna, Austria., Semmelweis University, Budapest, Hungary., University of California, San Francisco School of Medicine, San Francisco, CA, USA., University of California San Diego School of Medicine, La Jolla, CA, USA., Northwestern Feinberg School of Medicine, Chicago, IL, USA., Yale School of Medicine, New Haven, CT, USA. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41691567