Value of multiparametric MRI in predicting postoperative upgrading of prostate cancer with biopsy Gleason Grade Groups 3 + 3 and 3 + 4

Objectives This study assessed the effectiveness of multiparametric magnetic resonance image (mpMRI) in predicting postoperative prostate cancer (PCa) upgrading with biopsy Gleason Grade Groups (bGGs) 3 + 3 and 3 + 4. Methods We gathered retrospective data from clinical and mpMRI results from 145 patients with PCa. All patients underwent biopsies and then radical prostatectomy (RP). We compared the characteristics of the Gleason Grade Group (GG) upgrading group and non-upgrading group. To assess predictors of GG upgrading after RP, we performed univariable and multivariable logistic regression analyses. Moreover, to determine the prediction efficacy for GG upgrading after RP, we calculated the areas under the curve (AUCs) through a receiver operating characteristic curve analysis. Results We observed 83 cases with bGG 3 + 3, and 62 cases with bGG 3 + 4. Of the 145 patients, 81 cases (55.9%) exhibited GG upgrading, while 64 cases (44.1%) did not. The GG upgrading group demonstrated a significantly greater proportion of cases at the base than the non-upgrading group. Moreover, the GG upgrading group exhibited a higher grade of extraprostatic extension than the GG non-upgrading group (both P < 0.05). The clinical model demonstrated an AUC of 0.621, while the mpMRI model showed a higher AUC of 0.707. The composite model incorporating both clinical and mpMRI variables showed enhanced predictive ability (AUC=0.722) compared with the clinical-only model (P = 0.017). Conclusions Compared with standalone clinical assessment, the combined mpMRI-clinical approach enhances prediction accuracy for postoperative GG upgrading, which can decrease undertreatment rates in PCa management. Advances in knowledge MpMRI can help predict postoperative PCa upgrading with bGGs 3 + 3 and 3 + 4.