PI-RADS 3 LESIONS: A COMPREHENSIVE ANALYSIS OF MALIGNANCY PREVALENCE, INSTITUTIONAL COMPARISON, AND PREDICTIVE FACTORS

Abstract

Objective: To characterize cancer detection rates and risk factors in PI-RADS 3 prostate lesions and compare institutional data with published studies (1,2). Methods: We retrospectively reviewed 300men who under wentbiopsyforPI-RADS3lesionsatourcenter(May2017–May2025).Clinical(age,PSA,prior biopsy) and imaging (prostate volume, lesion size) variables were analyzed. Outcomes were any prostate cancer (PCa) and clinically significant PCa (csPCa, Gleason ≥3+4) on pathology. Univariable and multivariable logistic regression assessed predictors (yielding odds ratios, OR). Results were compared toten published cohorts(3,4). Results: PC a was found in 119/300(39.7%) and cs PC a in 32/300(10.7%) of cases. Univariate analysis showed that PSA (mean 12.3 vs 5.4 ng/mL, p<0.0001) and PSA density (mean 0.409 vs 0.167 ng/mL/cc, p<0.0001) were significantly higher in men with PCa. In multivariate models, PSA density≥0.15 predicted both PC a(OR≈5.3,95%CI2.82–9.79,p<0.0001) and cs PC a(OR≈10.0,95%CI2.15– 46.8,p=0.003)(Table2). Age, prostate volume, prior negative biopsy, and lesion size were not independently significant.Thesefindingsalignwithpriorreports:ourcsPCarate(10.7%) is comparable to some series (e.g. 10.1%(5),7.8%(4)) and lower than others(16–32%(1,3)). Conclusion:Aboutone-thirdofPI-RADS3 lesionsharboredcancer,with~11%clinicallysignificant.ElevatedPSAdensityemergedasthestrongestrisk factor, consistent with published data (1,6). IncorporatingPSAdensityandclinicalcontextmayimprovestratificationofPI-RADS3lesionsandguidebiopsydecisions.