LAUSR

OBJECTIVE To assess the whole pathology spectrum of PI-RADS 3 MRI lesions using systematic (SB), targeted biopsy (TB), and radical prostatectomy (RP) specimens' analysis. METHODS From a prospective database of patients undergoing RP after a combination of SB (median 12 cores) and fusion TB (median 3 cores), we included 150 PI-RADS 3 cases. Clinically significant PCa (csPCa) was defined by a grade group 2 or more. The primary endpoints were the unfavourable features in RP specimens. RESULTS TB was negative in 20.7%. Final grade group 3 or more and a pT3 stage was reported in 36.7% and 38.7% of RP specimens. Upgrading rate was 38.2% between biopsy and RP specimens. Concordance rate between grade group on TB and RP was only 38.0%. The two independent predictive factors for unfavourable disease (pT3-4 and/or final grade group 3-5) were PSAD (p=0.001) and presence of csPCa on TB (OR 3.7; p=0.001). The risk of unfavourable disease was increased by 2.3-fold and 5.8-fold in case of PSAD between 0.15 and 0.20, and >0.20 ng/ml/gr, respectively. The 5-year biochemical RFS rate was 93.2%. CONCLUSIONS PI-RADS 3 lesions exhibited aggressive features in almost 40% of cases. PSA density and presence of csPCa on targeted biopsy are independent predictive factors for high grade and/or extraprostatic disease. A combination of SB and TB improve the grade prediction compared to TB alone.