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Purpose <p>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.</p> Methods <p>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.</p> Results <p>We included eleven studies (<i>n</i> = 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, <i>p</i>&lt;.001). Compared to PI-RADS 1–2, the presence of PI-RADS 3 (HR:1.88, 95%CI: 1.29–2.74, <i>p</i>=.008), PI-RADS 4 (HR:2.73, 95%CI: 2.08–3.58, <i>p</i>&lt;.001), or PI-RADS 5 (HR:3.69, 95%CI: 2.50–5.45, <i>p</i>&lt;.001) lesions were associated with an increased risk of upgrade.</p> Conclusions <p>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.</p>

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Association between baseline prostate MRI PI-RADS classification and risk of Gleason upgrade during active surveillance: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年2月15日

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  • 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

摘要

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.