Comparison of MRI Semiology of PI-RADS 3 and PI-RADS 4 Categories with the Results of Stereotactic MRI-Guided Prostate Biopsy
Vol. 72 No. 4 (2026), ORIGINAL ARTICLES. CLINICAL RESEARCH
Vol. 72 No. 4 (2026)

Comparison of MRI Semiology of PI-RADS 3 and PI-RADS 4 Categories with the Results of Stereotactic MRI-Guided Prostate Biopsy

ORIGINAL ARTICLES. CLINICAL RESEARCH
https://doi.org/10.37469/0507-3758-2026-72-4-2587
Published 15.09.2026
Daria Igorevna Kuplevatskaya
Saint Petersburg State University Institute of Medicine
https://orcid.org/0000-0002-3395-7269
Vladimir Igorevich Kuplevatsky
Limited Liability Company “Diagnostic and Treatment Center of the International Institute of Biological Systems named after Sergey Berezin,” Saint Petersburg, Russian Federation
https://orcid.org/0000-0001-9753-1913
Marlen E. Topuzov Topuzov
Северо-Западный государственный медицинский университет им. И. И. Мечникова
https://orcid.org/0000-0001-7765-0122
Сергей Сергеевич Водопьян
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia, Saint Petersburg, Russian Federation
https://orcid.org/0009-0009-8708-8044
Nikita V. Surnin
Limited Liability Company “Diagnostic and Treatment Center of the International Institute of Biological Systems named after Sergey Berezin,” Saint Petersburg, Russian Federation
https://orcid.org/0009-0001-9621-3822
Tatyana Nikolaevna Trofimova
Saint Petersburg State University Institute of Medicine
https://orcid.org/0000-0003-4871-2341
Timur Marlenovich Topuzov
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia, Saint Petersburg, Russian Federation
https://orcid.org/0000-0002-5040-5546
Mikhail Atamas
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia, Saint Petersburg, Russian Federation
https://orcid.org/0009-0001-5211-1170
Sabina Familevna Abuzarova
North-Western State Medical University named after I.I. Mechnikov, Ministry of Health of Russia, Saint Petersburg, Russian Federation
https://orcid.org/0009-0009-4075-3588
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Keywords

prostate cancer
PI‑RADS
MRI‑guided biopsy
multifocality
Gleason

How to Cite

Kuplevatskaya, D. I., Kuplevatsky, V. I., Topuzov , M. E. T., Водопьян, С. С., Surnin, N. V., Trofimova, T. N., Topuzov, T. M., Atamas, M., & Abuzarova, S. F. (2026). Comparison of MRI Semiology of PI-RADS 3 and PI-RADS 4 Categories with the Results of Stereotactic MRI-Guided Prostate Biopsy. Voprosy Onkologii, 72(4), 2587. https://doi.org/10.37469/0507-3758-2026-72-4-2587
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Abstract

Introduction. Prostate cancer (PCa) is one of the most common malignancies in men. Multiparametric MRI (mpMRI) enables risk stratification of lesions using the PI‑RADS system, but management of PI‑RADS 3 lesions remains controversial.

Aim. To compare MRI features of PI‑RADS 3 and PI‑RADS 4 lesions with histopathological results of MRI‑guided stereotactic prostate biopsy.

Materials and Methods. A retrospective analysis of 80 prostate MRI examinations performed between 2019 and 2024 . Ninety‑eight target lesions were evaluated: 27 PI‑RADS 3 and 71 PI‑RADS 4. All patients underwent MRI‑guided stereotactic prostate biopsy followed by histological verification.

Results. Prostate cancer was verified in 78 of 98 lesions 79,6% (70,8%; 86,6%). The detection rate of prostate cancer was 48.1% (30,3%; 66,4%) for PI‑RADS 3 and 91,5% (83,4%; 96,4%) for PI‑RADS 4 (p<0.0001).  PI‑RADS 3 lesions were mostly Gleason 6 (3+3), while PI‑RADS 4 lesions were predominantly Gleason 7 (3+4). In 44,8% (34,2%; 55,9%) of cases, multifocal growth outside the target lesion was additionally detected, while the degree of tumor differentiation in additional cancer foci was similar to or higher than in the established target lesion. The median value for the lesion size (cm3) was 0,295 (0,13; 0,59), the median value for the Gleason score was 7 (6; 7), no significant correlation was found between them (p=0.08).

Conclusion. PI‑RADS 4 lesions are strongly associated with clinically significant prostate cancer and require mandatory targeted biopsy. For PI‑RADS 3, biopsy decisions should be individualized considering PSA level, patient age, and clinical history. The findings highlight the limitations of PI‑RADS v2.1 in differentiating benign and malignant lesions.

https://doi.org/10.37469/0507-3758-2026-72-4-2587
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