Pockros B, Stensland KD, Parries M, et al. - In prostate cancer cases, PI-RADS (Prostate Imaging Reporting and Data System) scores can independently predict upstaging events and could have a crucial role in predicting biochemical recurrence and lymph node metastasis. Inclusion of PI-RADS into modern nomograms is advised for more accurate prediction of lymph node metastases and the likelihood of biochemical recurrence.

• In this retrospective study of 294 patients who had a prostate multiparametric magnetic resonance imaging and radical prostatectomy between 2016 and 2020, experts assessed the association of PI-RADS scores with prostate cancer upstaging.

• Univariable analysis revealed significantly higher PI-RADS scores (odds ratio [OR] 2.34) in patients who were upstaged on final pathology but similar PSA-D (prostate-specific antigen density) (OR 2.70) than patients who remained pT1 or pT2 on final pathology.

• In the multivariable analysis, PI-RADS continued to be independently significantly linked with upstaging, implying that it represents an independent risk predictor for upstaging.

• Only patients with PI-RADS 4 or 5 lesions (n = 15) developed lymph node metastasis.

• A predictive AUC of 0.69 for upstaging events was achieved with the model using PSA-D, biopsy Gleason grade, and PI-RADS, an improvement from 0.59 using biopsy Gleason grade alone.